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Background
Peritoneal dissemination occurs approximately in 8 % of patients with colorectal cancer at the time of diagnosis and in about 25 % more at the time of disease recurrence. It has been traditionally seen as a universally lethal condition with no reasonable treatment options as most patients will present in an advanced stage.
Methods
We reviewed the records of all patients in our colorectal cancer with peritoneal dissemination database from 2005 to 2009. A retrospective analysis of key clinical and histopathological features including their TNM classification at the time of diagnosis of their primary tumor and their Peritoneal Surface Disease Severity Score (PSDSS) at the time of diagnosis of their peritoneal dissemination was carried out.
Results
Twenty eight patients with metachronous peritoneal dissemination were identified. There were 17 (61%) male patients. Mean age was 54 years. There were 7 patients with stage II (A or B) and 21 patients with stage III (A, B or C). Mean overall time to developing carcinomatosis was 27.8 months amongst all 28 patients. There were 6 patients with stage IIIC. Mean time to developing carcinomatosis was 16.8 months in this group and 5 out of 6 (83%), presented with a PSDSS of 4, making them not candidates for cytoreductive surgery and HIPEC.
Conclusion
It appears from these data that patients with stage IIIC colorectal cancer develop carcinomatosis at a faster rate and in a more virulent form when compared to other stages. Trials at preventing carcinomatosis in this group of patients are needed.