Multimodality treatment of colorectal peritoneal metastases: Towards evidence-based practice

This thesis focuses on patients with peritoneal metastases of colorectal cancer. Part 1 shows that the hospital of diagnosis with this disease seems to influence the probability of undergoing curative intent surgery and survival. Part 2 focuses on patients with operable peritoneal metastases undergoing curative intent surgery. Internationally, these patients increasingly receive chemotherapy before and after surgery, while nothing is known about the benefits of chemotherapy in this setting. This thesis shows that chemotherapy before and after surgery is safe, tolerable, and potentially effective. Part 3 focuses on patients with inoperable peritoneal metastases who cannot be cured. Internationally, these patients increasingly undergo PIPAC (i.e. intra-abdominal aerosol chemotherapy), while there is no available research supporting the use of PIPAC in this setting. This thesis shows that PIPAC is feasible and seems biologically active, but leads to (sometimes severe) adverse events and transient worsening of quality of life.