Conversion surgery after repeated intraperitoneal chemotherapy in unresectable peritoneal metastatic colorectal cancer: a narrative review of the literature
A partir d'une revue de la littérature publiée jusqu'au 1er décembre 2025 (18 études), cette étude examine l'intérêt, pour des patients présentant des métastases péritonéales ayant pour origine un cancer colorectal inopérable, d'une chimiothérapie intrapéritonéale répétée par cathéter ou pressurisée par aérosols pour permettre une chirurgie curative
Peritoneal metastases from colorectal cancer (CRC-PM) are known to respond poorly to systemic chemotherapy. Therefore, in patients with irresectable CRC-PM, treatments with repeated administration of intraperitoneal chemotherapy via pressurized intraperitoneal aerosol chemotherapy (PIPAC) or catheter-based intraperitoneal chemotherapy (CBIPC) have been introduced. Currently, it is unknown whether such palliative-intent therapy may play a role in converting patients with irresectable CRC-PM into candidates for cytoreductive surgery (CRS). The current study reviewed all literature available up to 1st December 2025 investigating palliative intraperitoneal therapies in patients diagnosed with CRC-PM. Inclusion of articles was further based on the availability of conversion surgery data. Data on safety, response and survival outcomes were also collected. In total, 14 studies on PIPAC and 4 studies on CBIPC were included. Conversion to CRS rates after bidirectional treatment in retrospective studies were up to 27% with PIPAC-Oxaliplatin and to 34% with CBIPC-Paclitaxel. In clinical trials, a conversion rate of 17% and 22% were found respectively after PIPAC-Oxaliplatin monotherapy and CBIPC-Irinotecan plus systemic therapy. Outcomes after conversion surgery are rarely reported. Repetitive intraperitoneal chemotherapy was found to enable conversion to CRS in part of the patients with irresectable CRC-PM. Though promising, the current review highlights the heterogeneity of data on palliative intraperitoneal therapies in irresectable CRC-PM, hampering the intra- and across modality comparison of results. Further research is needed to indicate the optimal delivery system, intraperitoneal agent, timing of treatment initiation, number of cycles and bimodality.
European Journal of Surgical Oncology , résumé, 2026