Therapeutic Management of a Single Peritoneal Metastasis in Colorectal Cancer: A Case Report

Abstract

Colon cancer may give rise to peritoneal metastases, which, if few in number and resectable in an operable patient, may benefit from curative therapeutic management, essentially local treatment (mainly surgery) and chemotherapy; surgery first or chemotherapy requires specialist advice. Case report: We report the case of a diabetic patient undergoing dietary hygiene measures, diagnosed with a moderately differentiated and infiltrating colonic adenocarcinoma, with mutation in RAS status and microsatellite stability; and 4 synchronous hepatic metastatic lesions. The patient received neo-adjuvant chemotherapy followed by liver surgery; and FOLFOX-based adjuvant chemotherapy followed by colon surgery. One year after primary surgery, a peritoneal nodule appeared in the pouch of Douglas. The patient was operated on immediately and then treated with adjuvant chemotherapy (capecitabine). Conclusion: it is possible to standardize therapeutic approaches to colorectal cancer metastatic to the liver; but when it comes to peritoneal oligo progression, a situation which is not exceptional, multidisciplinary consultation meetings and broader involvements are needed for therapeutic choices, and their appropriate timing.