This is the main difference between these two alternatives.

The aggressive cytoreductive approach is intended to cure. If the curative potential is lost, the validity of the treatment at least for colorectal cancer could be questioned. The massing evidence for CRS and IPC treatment of isolated PM disease is now showing an excellent 5-year disease-free survival between 15% and 32% (18). This needs to be the main aim when reviewing results from colorectal PM/HM as well. There needs to be a curative potential for this treatment to remain as a valid treatment option. Unfortunately, few studies report the disease-free Inhibitors,research,lifescience,medical survival. There is a need for change here. As more centres are now starting to apply the concepts of CRS in colorectal PM Inhibitors,research,lifescience,medical disease, there will come more reports on colorectal PM/HM as well. As such, it is important in future

studies to keep the disease free survival a key aspect of the outcome reporting. It is also noteworthy that our study hade a significantly higher mean PCI score than the others studies (Table 4). Inhibitors,research,lifescience,medical However, the R1 find more resections still produced similar results as the other studies despite the increase in mean PCI. Since the consensus statement from Milano stated that concomitant HM with 1-3 metastases appears to not affect the overall survival of colorectal PM, our institution has implemented this in clinical practice (16). We have previously not performed laparoscopic staging and high PCI values have not automatically been cause

Inhibitors,research,lifescience,medical for exclusion or open-and-close. Instead, at exploration a decision is made by the surgeon whether or not it is technically possible to reach a CC 0 score regardless of the PCI. Other institutions have had other policies (3,6); and for this reason, this study has a significantly higher mean PCI score. Despite this, results from our institution remain optimistic, but further investigations are needed particularly to determine if long term disease-free survival is achievable. This is a necessity if the treatment is to be successful in combined colorectal peritoneal and hepatic metastases. Since our Inhibitors,research,lifescience,medical study showed that concomitant Adenosine HM appears to affect recurrence rates and disease free survival, one cannot assume that the same improvement over systemic chemotherapy exists as it does for PM alone. Therefore, there is a need to re-evaluate this treatment option for combined PM/HM disease. A randomised trial between systemic chemotherapy vs. CRS, IPC, and hepatic resections is called for. Furthermore, the Milano consensus may need to be revised as new evidence is brought forth demonstrating the negative prognostic impact of concomitant hepatic disease. In conclusion, concomitant treatment of PM and HM with CRS/IPC/hepatic resections is feasible with no increase in morbidity or mortality, but the risk of recurrences is significantly higher in the PM/HM group with a tendency towards worse DFS.