Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: Prognosis and treatment of recurrences in a cohort study

• Published in: European journal of surgical oncology Vol. 38; no. 6; pp. 509 - 515
• Main Authors: Cashin, P.H, Graf, W, Nygren, P, Mahteme, H
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2012
• Subjects: Adult; Aged; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Carcinoma - drug therapy; Carcinoma - mortality; Carcinoma - secondary; Carcinoma - surgery; Chemotherapy, Adjuvant; Chemotherapy, Cancer, Regional Perfusion - methods; Cohort Studies; Colorectal cancer; Colorectal Neoplasms - pathology; Cytoreductive surgery; Female; Hematology, Oncology and Palliative Medicine; HIPEC; Humans; Hyperthermia, Induced; Intraperitoneal chemotherapy; Kaplan-Meier Estimate; Kirurgi; Male; Middle Aged; Neoplasm Recurrence, Local - surgery; Peritoneal carcinomatosis; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - surgery; Prognosis; Proportional Hazards Models; Recurrences; Reoperation; Risk Assessment; Risk Factors; Surgery; Treatment Outcome; HIPEC; Intraperitoneal chemotherapy; Cytoreductive surgery; Colorectal cancer; Peritoneal carcinomatosis; Recurrences
• ISSN: 0748-7983; 1532-2157; 1532-2157
• DOI: 10.1016/j.ejso.2012.03.001

Abstract Background Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) treatment of colorectal peritoneal carcinomatosis (PC) is gaining acceptance, but controversy remains. The primary aims were to analyse the outcome and prognostic variables of colorectal PC patients treated with CRS and IPC, and to report on the outcome of additional surgical treatments of subsequent recurrences. Methods Patients referred for treatment of colorectal PC between 1996 and 2010 were included in a cohort. The following data was collected: clinicopathological parameters, survival, recurrences, perioperative chemotherapy and type of IPC (hyperthermic intraperitoneal chemotherapy, HIPEC; or sequential postoperative intraperitoneal chemotherapy, SPIC). Multivariable analyses were conducted on potential prognostic factors for overall survival (OS). Results In the 151-patient cohort, the median OS was 34 months (range: 2–77) for CRS and HIPEC with five-year survival predicted at 40% (five-year disease-free survival 32%). For CRS and SPIC, the OS was 25 months (range: 2–188) with five-year survival at 18%. Open-and-close patients survived 6 months (range: 0–14) with no five-year survival (HIPEC vs. SPIC p  = 0.047, SPIC vs. open-and-close p  < 0.001). Adjuvant systemic chemotherapy was a noteworthy independent prognostic factor in the multivariable analysis. OS for patients undergoing additional surgical treatment of recurrences was 25 months vs. 10 months with best supportive care or palliative chemotherapy ( p  = 0.01). Conclusion Substantial long-term survival is possible in patients with colorectal PC. HIPEC was associated with better OS than SPIC and adjuvant systemic chemotherapy may improve the outcome in patients. Good OS is achievable in selected patients undergoing additional surgical treatment of isolated liver or peritoneal recurrences after prior complete CRS.