Metastases of colorectal cancer to the liver and peritoneum: comparison of surgical paradigms

The treatment of metastatic colorectal cancer is evolving. Although the advent of new chemotherapeutic and biologic agents has certainly improved the outlook for many patients, surgical resection in certain subsets of patients with advanced colorectal cancer is the only chance for long-term survival. Traditionally, patients with limited hepatic or pulmonary metastases were the only candidates for metastasectomy. Since hepatic metastases are the most common, there is a tremendous amount of data on the efficacy of this approach and the clinical outcomes. However, more recently, another metastatic site in colorectal cancer has received attention as a potential organ system that can be completely extirpated with improved clinical outcomes. This is the peritoneum, and tumor lesions at this site are referred to as peritoneal surface disease. Macroscopically complete cytoreductive surgery in combination with intraperitoneal hyperthermic chemotherapy for peritoneal surface disease has been demonstrated to produce survival outcomes equal to liver resection for hepatic metastases. This review will examine recent evidence regarding these two surgical oncology paradigms and compare patient populations, clinical outcomes and future challenges.