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International Journal of Surgical Oncology
Volume 2011, Article ID 915078, 8 pages
http://dx.doi.org/10.1155/2011/915078
Review Article

Second-Look Surgery for Colorectal Cancer: Revised Selection Factors and New Treatment Options for Greater Success

Washington Cancer Institute, 106 Irving Street, NW, Suite 3900, Washington DC,WA 20010, USA

Received 10 August 2010; Accepted 18 October 2010

Academic Editor: E. W. Martin

Copyright © 2011 Paul H. Sugarbaker. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Proper indications for second-look surgery in patients with colorectal cancer have always been a controversial subject. The surgical literature suggests benefit in a reoperation, where a limited extent of cancer is discovered and then resected with negative margins. However, patients are often subjected to a negative exploratory laparotomy or an intervention that is unable to achieve an R-0 resection; in these circumstances, little or no benefit occurs. Unfortunately, an unsuccessful repeat intervention may place the patient in a worse condition, especially if morbidity occurs. This paper seeks to identify the clinical parameters of a primary colorectal cancer and a followup plan that are associated with cancer recurrence that can be definitively addressed by the second look surgery. New surgical technologies, including cytoreductive surgery with peritonectomy and perioperative intraperitoneal chemotherapy with hyperthermia, are suggested for use in this group of patients. This new management strategy used in patients with local-regional recurrence may result in a high proportion of patients converted from a second-look positive patient to a long-term survivor.