ASO Author Reflections: Advanced Imaging Allows Better Detection of Peritoneal Metastases

Excerpt

Peritoneal metastases (PM) are diagnosed in up to 30% of patients with colorectal cancer, especially in patients with T4 disease.1 Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) improve the survival of patients with colorectal PM, resulting in an overall survival of 56 months in selected patients with limited peritoneal disease.2 Unfortunately, PM are often missed during elective primary tumor resection. Second, during follow-up after initial curative treatment, PM are mostly diagnosed in an advanced stage. Current diagnostic imaging modalities such as positron emission tomography/computed tomography (PET/CT) have a detection limit of 5 mm and the multiple small peritoneal lesions are frequently missed.3 The presence of advanced intra-abdominal disease such as omental cake can be easily visualized, but curative options in this stage are limited. Since cytoreduction and HIPEC results in good survival in patients with limited peritoneal disease, accompanied by a low morbidity due to the limited amount of resections, extensive effort should be made to improve early diagnosis of PM. …