[Translational therapeutic strategies and timing of surgery for peritoneal metastasis in colorectal cancer].

Résumé

Peritoneal metastasis from colorectal cancer is characterized by aggressive biological behavior, rapid disease progression, and poor overall prognosis, making it one of the most challenging conditions in clinical practice. With advances in surgical techniques and multimodal treatment strategies, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy can achieve satisfactory cytoreduction in carefully selected patients, thereby conferring meaningful survival benefits. However, marked heterogeneity exists among patients with peritoneal metastases, and complete cytoreduction is not achievable in all cases. In addition, these procedures are technically demanding, associated with substantial surgical trauma, and accompanied by a high risk of postoperative recurrence. Against this background, conversion therapy has emerged as an important therapeutic approach, aiming to reduce tumor burden through systemic treatment and render initially unresectable or high-risk disease amenable to surgery. Nevertheless, key unresolved issues remain regarding how to achieve effective conversion and how to determine the optimal timing of surgical intervention. This review focuses on conversion strategies and surgical timing in colorectal cancer peritoneal metastasis, systematically summarizing current evidence, ongoing controversies, and areas of consensus, and proposing a framework for individualized clinical decision-making.