Adjuvant HIPEC to Prevent Colorectal Peritoneal Metastases in High-risk Patients

Inclusion Criteria:

* pathologically confirmed colorectal carcinoma;
* curative surgery;
* presence of at least one of the following risk-factors for the development of metachronous PM:

  * minimal synchronous PM (nodules ≤1cm in the omentum and/or close to the primary tumor), completely resected at the same time as primary tumor;
  * synchronous ovarian metastases, also resected at the same time as primary tumor;
  * primary tumor either penetrating visceral peritoneum (T4a),
  * primary tumor directly invading other organs (T4b);
* signature of an informed consent form.
* intention to start adjuvant systemic therapy and postoperative follow-up;
* performance status ≤2 according to the Eastern Cooperative Oncology Group score;
* no significant co-morbidities.
* no active sepsis
* no impaired cardiac function (history of previous cardiac failure, or ejection fraction \<40%)
* no impaired renal function (serum creatinin \> 1.5 normal value or creatinin clearance \< 60 mL/min);
* no impaired hepatic function (serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, bilirubin \> 1.5 normal value);
* no impaired bone marrow function (leucocytes \< 4000/mm3 ; neutrophils \< 1500/mm3; platelet \< 80000/mm3)
* no impaired lung function (diagnosis of severe chronic obstructive pulmonary disease , or forced expiratory volume at one second \< 50% or a diffusion capacity of lung for carbon monoxide \< 40% age adjusted).

Exclusion Criteria:

* extensive PM (nodules \>1cm, and/or nodules outside the omentum and/or beyond the close vicinity of the primary tumor);
* extra-abdominal/hepatic metastases;
* emergency presentation (bleeding, perforated, or occlusive primary);
* bleeding diathesis or coagulopathy
* history of previous neoplasm during the past three years, excluding skin spinocellular/basocellular carcinoma;
* preoperative pelvic radio-chemotherapy