A multidisciplinary approach for peritoneal carcinomatosis and bilobar liver metastases from colorectal cancer: case report and review of the literature

BACKGROUND Peritoneal carcinomatosis develops in 15% of patients with primary colorectal cancer (CRC) and in 25% of those with recurrence. Liver metastases are also frequent and appear at some time in 35-55% of patients with CRC. When both conditions are present and treated palliatively, the expected median survival is 5-6 months. Recent publications suggest survival is improved when R0 resection of both peritoneal and liver diseases is achieved. CASE PRESENTATION A 36-year-old woman with synchronous peritoneal and liver metastases of colorectal origin was treated with a stepwise approach consisting of initial cytoreductive surgery, minor liver resection, intraperitoneal intraoperative hyperthermic chemotherapy, adjuvant chemotherapy, right portal embolization, and finally, right hepatectomy achieving an R0 resection. The patient is alive and free of disease after 30 months of follow-up. DISCUSSION Patients with peritoneal carcinomatosis and liver metastases from CRC must be carefully evaluated by multidisciplinary oncological teams in order to offer the possibility of surgery to obtain an R0 resection in selected patients (especially if the peritoneal cancer index is <19 and there is resectable or potentially resectable metastatic liver disease).