Ricerc@Sapienza

Colorectal cancer is one of the leading causes of cancer death in developed countries. Surgery is the primary treatment and recurrence following surgery is a major problem and is often the ultimate cause of death. In colon cancer endoperitoneal recurrence account for 10% of all recurrences and generally occurs within 3 years of resection. Specific features of the primary tumor like size and depth of bowel wall invasion (pT3-pT4), which determine a specific clinical evolution ( exfoliation of cancer cells) are responsible for endoperitoneal recurrence. Cytoreductive Surgery (CRS) defined as removal of macroscopic abdominal and peritoneal disease combined with Hyperthermic Perioperative Chemotherapy (HIPEC) is the treatment considered standard of care for selected patients with moderate to small volume peritoneal metastases secondary to colorectal cancer. Nevertheless treatment of locoregional recurrence and peritoneal metastases in colon cancer are disappointing first because only 30% of patients can be surgically treated and second because of this 30% only 15- 30% survive 5 years, leaving only 10% of patients with a chance of being cured. In surgical series, the majority (around 70%), of patients with a diagnosis of colonic cancer operated with curative intent, have a pT3-4 tumor, which is the high-risk class of patients for local recurrence and peritoneal metastases. In this scenario the most effective strategy to combat endoperitoneal recurrence seems prevention. In studies performed in our Institution, we showed how a proactive management of peritoneal metastases in colon cancer patients considered at high-risk for peritoneal recurrence according specific features (pT3, pT4 any N, M0) influence outcome. These results should be validated by larger controlled studies, and this is the aim of the PROMENADE protocol, to verify if surgery combined with HIPEC could represent a mean of tertiary prevention of endoperitoneal recurrence in high-risk colon cancer.