European Journal of Surgical Oncology xxx (xxxx) xxx

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European Journal of Surgical Oncology

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“Unveiling controversies: The role of HIPEC in colorectal cancer peritoneal metastasis"

To the Editor, precise diagnosis of different types of T4 colorectal cancer, allowing

An advanced stage of colorectal cancer (CRC) known as peritoneal
metastasis (PM) is linked to a poor prognosis and frequently a low
quality of life. PM is linked to a median overall survival (mOS) of just 6
months in the absence of treatment. However, multimodal approaches
to treating PM have emerged in recent years, made possible in part by
improved systemic treatment plans [1]. Between 30 and 40 percent of
patients with colorectal cancer experience PM during surveillance and
follow-up. PM, being asymptomatic, are typically discovered during
staging, surveillance, or unintentionally during surgery [2].
A recent study by Zheng et al. discusses a controversial treatment
modality for PM in CRC i.e Hyperthermic Intraperitoneal Chemotherapy
(HIPEC). This study discovers the impact of HIPEC in adjuvant to
cytoreductive surgery. The use of HIPEC has had different results in
different studies, hence its effectiveness in the prognosis of PM in CRC
remained controversial. But this study explains that in the patients
diagnosed with cT4N0-1M0 CRC, prophylactic HIPEC has the potential
to improve prognosis; however, it is unlikely to show any significant
improvement in those with cT4N2M0 CRC. Additionally, there seems to
be a lesser chance of PM following laparoscopic surgery after HIPEC for
T4 stage CRC. This data highlights the value of HIPEC in reduction of
risks with CRC treatment [3]. The idea of different types of T4 colorectal
cancer explained in the study gives way to further research on the dif­
ferential diagnosis of cT4N0-1M0 CRC and cT4N2M0 CRCs, to produce
individualized treatment for this complication.
Tumor deposits (TDs) and extramural venous invasion (mrEMVI)
identified by magnetic resonance imaging (MRI) have been recognized
as risk factors for the development of distant metastases (DMs) and local
recurrence in rectal cancer [4]. This has the potential of a good prog­
nostic marker, permitting the differential diagnosis between
cT4N0-1M0 CRC and cT4N2M0 CRC. This could help determine which
patients might benefit from a more individualized treatment program,
without leading to overtreatment. The conventional medical paradigm
is progressively being altered by artificial intelligence, and thus repre­
sents the future course and trend of medical advancement for humans.
An AI based screening model, integrated with MRI, can help in more
differential care of patients, and ultimately enhancing the prognosis and
overall survival of the disease.
Funding
None.
Declaration of Competing interest
None declared.
References
[1] Breuer E, Hebeisen M, Schneider MA, Roth L, Pauli C, Frischer-Ordu K, et al. Site of
recurrence and survival after surgery for colorectal peritoneal metastasis. JNCI: J
Natl Cancer Inst 2021 Aug 2;113(8):1027–35.
[2] Narasimhan V, Ooi G, Michael M, Ramsay R, Lynch C, Heriot A. Colorectal perito­
neal metastases: pathogenesis, diagnosis and treatment options – an evidence-based
update. ANZ J Surg 2020 Sep 4;90(9):1592–7.
[3] Zheng Y, Zhang J, Chen C, Gong Z, Wang Z, Deng Q, et al. Prophylactic hyper­
thermic intraperitoneal chemotherapy in T4 colorectal cancer: can it improve the
oncologic prognosis? – a propensity score matching study. Eur J Surg Oncol 2024
Feb;50(2):107958.
[4] Schaap DP, Voogt ELK, Burger JWA, Cnossen JS, Creemers GJM, van Lijnschoten I,
et al. Prognostic implications of MRI-detected EMVI and tumor deposits and their
response to neoadjuvant therapy in cT3 and cT4 rectal cancer. Int J Radiat Oncol
Biol Phys 2021 Nov;111(3):816–25.
Hasnain Wajeeh us Saqib*, Ali Abdullah, Abdul Majid
Islamic International Medical College, Riphah International University,
Rawalpindi, Pakistan
*
Corresponding author. Riphah International University Islamic
International Medical College, Pakistan.
E-mail addresses: hassanhussain4444444@gmail.com (H.W. Saqib),
ali12091123@gmail.com (A. Abdullah), abdulmajidb505@gmail.com
(A. Majid).

https://doi.org/10.1016/j.ejso.2024.108345
Received 14 March 2024; Accepted 12 April 2024
Available online 16 April 2024
0748-7983/© 2024 Elsevier Ltd, BASO The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Please cite this article as: Hasnain Wajeeh us Saqib et al., European Journal of Surgical Oncology, https://doi.org/10.1016/j.ejso.2024.108345