***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Cytoreductive surgery (CRS)/Hyperthermic Intraperitoneal Chemotherapy ( HIPEC ) is associated with prolonged survival in selected patients with peritoneal surface disease . Yet , for elderly patients ( older than 70 years of age )  CRS/HIPEC is controversial , due to associated morbidity . Methods A retrospective analysis of a prospect i ve data base of 950 procedures was performed . Type of malignancy , demographics , performance and resection status , hospitalization , morbidity , mortality , and survival were review ed . Results A total of 81 patients ( median age 73 , range 70–87 ) underwent CRS/HIPEC between 1991 and 2011 . Median follow-up was 48.1 months . Complete cytoreduction was achieved in 44 % . Median survival was 31.8 months for appendiceal cancer , 41.5 for mesothelioma , 54.0 for ovarian cancer , 13.2 for colon cancer , and 7.6 for gastric cancer . The 30-day mortality was 13.6 % . The combined grade III and IV morbidity was 38 % . Median ICU and hospital stay for uncomplicated patients was 1 and 8 days , respectively . The 3-month mortality was 27.4 % . There were no deaths in the octogenarian group . In stepwise multivariate analysis , type of primary ( p = 0.03 ) , albumin ( p = 0.02 ) , and R status ( p = 0.007 ) were predictive of survival only in the absence of complications . Splitting the data at the midpoint of surgical experience , there was a drop in 1- and 3-month mortality over time to 9.5 and 19.3 % , respectively , while the median survival increased from 11.2 ( N = 39 ) to 46.9 months ( N = 42 ) . Conclusions HIPEC in the elderly is associated with a steep learning curve and considerable morbidity and mortality . However , age alone is not a contraindication for the procedure . Institutional experience and stringent patient selection are key factors for prolonged survival Objective : The aim of this prospect i ve study was to analyze the impact of second-look surgery in an attempt to treat peritoneal carcinomatosis ( PC ) at an early stage in a series of patients at high risk of developing PC from colorectal cancer . Background : The prognosis of colorectal PC has recently been improved with hyperthermic intraperitoneal chemotherapy ( HIPEC ) after complete cytoreductive surgery ( CCRS ) , and could be further improved if PC could be treated at an early stage . But , currently , the diagnosis of early PC is not accessible to imaging . Patients and Methods : From 1999 to 2006 , 29 patients without any sign of recurrence on imaging studies underwent second-look surgery 13 months after resection of the primary tumor . Patients were selected according to primary tumor-associated criteria : resected minimal synchronous macroscopic PC ( n = 16 ) , synchronous ovarian metastases ( n = 4 ) , perforated primary tumor ( n = 9 ) . Results : PC was found and treated with CCRS plus HIPEC in 16 of 29 ( 55 % ) cases , corresponding to 10 of 16 patients with initial PC , 3 of 4 patients with synchronous ovarian metastases and 3 of 9 patients with a perforated primary tumor . There was no postoperative mortality , and morbidity ( grade III/IV ) occurred in 14 % of cases . After a median follow-up of 27 months ( range , 6–96 ) , 8 of 16 patients treated with CCRS and HIPEC are free of disease , 4 relapsed in the peritoneum , and 4 developed isolated visceral metastases . Conclusion : Performing second-look surgery at 1 year in selected patients at high risk of developing PC allowed the early detection and treatment of PC in 55 % of cases . Our preliminary results have encouraged us to pursue this strategy and to evaluate it in a prospect i ve multicenter trial Introduction The treatment of peritoneal carcinomatosis is based on cytoreduction followed by hyperthermic intraperitoneal chemotherapy and combined with adjuvant chemotherapy . In 2003 , a r and omized trial was finished comparing systemic chemotherapy alone with cytoreduction followed by hyperthermic intraperitoneal chemotherapy and systemic chemotherapy . This trial showed a positive result favoring the studied treatment . This trial has now been up date d to a minimal follow-up of 6 years to show long-term results . Patients and Methods For all patients still alive , the follow-up was up date d until 2007 . In the original study , four patients were excluded — two because of no eligible histology/pathology and two because of major protocol violations . After r and omization , four patients in the HIPEC arm and six in the control arm were not treated using the intended therapy , one patient because of withdrawal , one because of a life-threatening other malignant disease and the others because of progressive disease before initiation of the treatment . During the follow-up , one patient was crossed over from the control arm and underwent cytoreduction and HIPEC for recurrent disease , after the assigned treatment was completed . The data from these patients were censored at the moment of the cross-over . Progression-free and disease-specific survival were analyzed using the Kaplan Meyer test and compared using the log rank method . The long-term results were studied in more detail to evaluate efficacy and toxicity . Results At the time of this up date , the median follow-up was almost 8 years ( range 72–115 months ) . In the st and ard arm , 4 patients were still alive , 2 with and 2 without disease ; in the “ HIPEC ’ arm , 5 patients were still alive , 2 with and 3 without disease . The median progression-free survival was 7.7 months in the control arm and 12.6 months in the HIPEC arm ( P = 0.020 ) . The median disease-specific survival was 12.6 months in the control arm and 22.2 months in the HIPEC arm ( P = 0.028 ) . The 5-year survival was 45 % for those patients in whom a R1 resection was achieved . Conclusion With 90 % of all events having taken place up to this time , this r and omized trial shows that cytoreduction followed by HIPEC does significantly add survival time to patients affected by peritoneal carcinomatosis of colorectal origin . For a selected group , there is a possibility of long-term survival Background We evaluate the long-term survival of patients with peritoneal carcinomatosis ( PC ) treated with systemic chemotherapy regimens , and the impact of the of the retrospective peritoneal disease severity score ( PSDSS ) on outcomes . Methods One hundred sixty-seven consecutive patients treated with PC from colorectal cancer between years 1987 - 2006 were identified from a prospect i ve institutional data base . These patients either received no chemotherapy , 5-FU/Leucovorin or Oxaliplatin/Irinotecan-based chemotherapy . Stratification was made according to the retrospective PSDSS that classifies PC patients based on clinical ly relevant factors . Survival analysis was performed using the Kaplan-Meier method and comparison with the log-rank test . Results Median survival was 5 months ( 95 % CI , 3 - 7 months ) for patients who had no chemotherapy , 11 months ( 95 % CI , 6 - 9 months ) for patients treated with 5 FU/LV , and 12 months ( 95 % CI , 4 - 20 months ) for patients treated with Oxaliplatin/Irinotecan-based chemotherapy .  Survival differed between patients treated with chemotherapy compared to those patients who did not receive chemotherapy ( p = 0.026 ) . PSDSS staging was identified as an independent predictor for survival on multivariate analysis [ RR 2.8 ( 95%CI 1.5 - 5.4 ) ; p < 0.001 ] . Conclusion A trend towards improved outcomes is demonstrated from treatment of patients with PC from colorectal cancer using modern systemic chemotherapy . The PSDSS appears to be a useful tool in patient selection and prognostication in PC of colorectal origin Purpose This nationwide study evaluated results of cytoreductive surgery ( CRS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for peritoneal metastasis of colorectal origin in the Netherl and s following a national protocol . Methods In a multi-institutional study prospect i ve data bases of patients with peritoneal carcinomatosis ( PC ) from colorectal cancer and pseudomyxoma peritonei ( PMP ) treated according to the Dutch HIPEC protocol , a uniform approach for the CRS and HIPEC treatment , were review ed . Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival . Results Nine-hundred sixty patients were included ; 660 patients ( 69 % ) were affected by PC of colorectal carcinoma and the remaining suffered from PMP ( 31 % ) . In 767 procedures ( 80 % ) , macroscopic complete cytoreduction was achieved . Three-hundred and thirty one patients had grade III – V complications ( 34 % ) . Thirty-two patients died perioperatively ( 3 % ) . Median length of hospital stay was 16 days ( range 0–166 days ) . Median follow-up period was 41 months ( 95 % confidence interval ( CI ) , 36–46 months ) . Median progression-free survival was 15 months ( 95 % CI 13–17 months ) for CRC patients and 53 months ( 95 % CI 40–66 months ) for PMP patients . Overall median survival was 33 ( 95 % CI 28–38 months ) months for CRC patients and 130 months ( 95 % CI 98–162 months ) for PMP patients . Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients . Conclusions The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP . It is assumed the uniform Dutch HIPEC protocol was beneficial Background To prospect ively investigate the diagnostic accuracy of a 64-section multi-detector row computed tomography ( CT ) for the detection of peritoneal metastases , with the use of surgery and histopathological findings as the reference st and ard . Methods The study cohort comprised 18 patients with peritoneal carcinomatosis who underwent multiphasic CT with a 64-section CT , 0–119 days before cytoreductive surgery . Transverse CT images along with isotropic reformatted coronal and sagittal images were prospect ively and independently evaluated by one of the five staff radiologists in an unblinded fashion . Results The overall sensitivity , specificity , positive , and negative predictive values of CT for the detection of peritoneal metastases were , respectively , 75 % ( 93 of 124 lesions ; confidence interval [ CI ] 68–84 ) , 92 % ( 118 of 128 ; CI 85–96 ) , 90 % ( 93 of 103 ; CI 83–95 ) , and 79 % ( 118 of 149 ; CI 72–86 ) . For lesions 0.5 cm in diameter or larger , CT yielded a mean sensitivity of 89 % ( 77 of 87 ; CI 75–97 ) , although sensitivity decreased to only 43 % ( 16 of 37 ; CI 28–56 ) for lesions < 0.5 cm in diameter . Conclusions 64-Section CT with the addition of isotropic reformatted coronal and sagittal images is a very effective technique in the detection of peritoneal metastases of 0.5 cm in diameter or larger , although sensitivity decreases remarkably for lesions < 0.5 cm in diameter AIM The present study was specifically design ed to assess the major clinical and pathological variables of patients with colorectal peritoneal carcinomatosis in order to investigate whether currently used criteria appropriately select c and i date s for peritonectomy procedures ( cytoreductive surgery ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) . PATIENTS AND METHODS Preoperative , operative and follow-up data on 146 consecutive patients presenting with peritoneal carcinomatosis of colorectal origin and treated by surgical cytoreduction combined with HIPEC in 5 Italian Hospital and University Centers were prospect ively entered in a common data base . Univariate and multivariate analyses were used to assess the prognostic value of clinical and pathologic factors . RESULTS Over a minimum 24-month follow-up , the overall morbidity rate was 27.4 % ( mortality rate : 2.7 % ) and was directly related to the extent of surgery . Peritoneal cancer index ( PCI ) , unfavorable peritoneal sites , synchronous or previously resected liver metastasis and the completeness of cytoreduction , all emerged as independent prognostic factors correlated with survival . CONCLUSIONS Until research provides more effective criteria for selecting patients based upon the biomolecular features of carcinomatosis , patients should be selected according to the existing independent prognostic variables PURPOSE Symptoms and complications of metastatic colorectal cancer ( mCRC ) differ by metastatic sites . There is a paucity of prospect i ve survival data for patients with peritoneal carcinomatosis colorectal cancer 
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Substantial consensus was also reached on the benefit of multidisciplinary team discussion and the achievability of a ( near ) complete cytoreduction ( CC0 - 1 ) without supporting evidence .