Purpose: Colorectal cancer (CRC) is extremely rare in the pediatric population, with limited guidance in the literature regarding optimal treatment strategies. Pediatric cases often present at advanced stages and may require aggressive multimodal therapy. This study presents a five-case series to evaluate the clinical presentation, surgical approaches, and the potential utility of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric CRC.
Method: We retrospectively reviewed 5 patients (4 boys, 1 girl) diagnosed and treated for colorectal cancer at our center between January 2012 and June 2025. Patient data including age, sex, symptoms, chemotherapy regimens, surgical interventions (including HIPEC), and outcomes were analyzed.
Results: The median age was 14.4 years (range: 12-16). Most patients presented with nonspecific symptoms such as abdominal pain, anemia, and rectal bleeding, resulting in delayed diagnosis. 4 patients received neoadjuvant chemotherapy (FOLFOX-6), however diagnosis was confirmed after operation in one patient. While low anterior resection was performed in 2 patients; tumor was unresectable in one patient and colostomy was performed for obstructive symptoms. 2 patients underwent multiple operations (subtotal colectomy, total colectomy, small bowel resections) due to disease extent, additionaly one of them with peritoneal carcinomatosis underwent extensive cytoreductive surgery followed by HIPEC, representing a rare application of this modality in the pediatric setting. Two patients achieved complete remission (CR) with long-term follow-up; however one of them later developed a secondary T-cell lymphoma and died. While two patients died of disease (DOD) despite intensive treatment, one patient with extensive disease is still undergoing adjuvant chemotherapy.
Conclusion: Pediatric colorectal cancer requires individualized, aggressive treatment plans. Complex surgical procedures including multistage resections and HIPEC may be considered in select advanced cases. This case series underlines the importance of early suspicion and multidisciplinary management and suggests a potential role for HIPEC in high-stage pediatric CRC with peritoneal involvement.
Keywords: colorectal cancer, children, hyperthermic intraperitoneal chemotherapy
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