Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective routine treatments for colorectal peritoneal metastases (PMs). However, the safety and efficacy of neoadjuvant chemotherapy (NAC) before CRS+HIPEC are poorly understood. Therefore, this study aimed to assess the perioperative safety and long-term efficacy for patients with synchronous colorectal PM who received NAC prior to CRS+HIPEC.Method Patients with synchronous colorectal PM who received NAC prior to CRS+HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. Clinicopathologic characteristics, perioperative parameters, and survival were compared between patients who underwent CRS+HIPEC with NAC (NAC group) and those who underwent CRS+HIPEC without NAC (non-NAC group).Results The study enrolled 52 patients, with 20 patients in the NAC group and 32 in the non-NAC group. In the NAC group, the proportion of patients with a peritoneal carcinomatosis index (PCI) score < 12 was significantly higher than that in the non-NAC group (80.0% vs 50.0%, P=0.031), and more patients received complete cyoreduction (80.0% vs 46.9%, P=0.018). The two groups had comparable grade III/IV complications and similar reoperation and mortality rates (P>0.05). However, patients who received NAC prior to CRS+HIPEC experienced lower platelet counts (151.9 vs 197.7 ×109/L, P=0.036) and neutrophil counts (4.7 vs 7.2×109/L, P=0.030) on postoperative day 1. Compared with the non-NAC group, more patients in the NAC group survived for two years (67.4% vs. 32.2%, respectively, P = 0.044). However, the CC score (HR, 2.99; 95% CI, 1.14-7.84; P=0.026), rather than NAC, was independently associated with OS in the multivariable analysis after controlling for confounding factors.Conclusion NAC administration before CRS+HIPEC can be regarded as a safe and feasible treatment for patients with colorectal PM with comparably low mortality and acceptable morbidity. Nevertheless, the administration of NAC before CRS+HIPEC conferred a greater survival benefit to patients, even though NAC was not identified as an independent factor for OS after controlling for confounding factors.

Background Currently, few studies have evaluated effectiveness of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in young patients with peritoneal metastasis (PM) of colorectal cancer (CRC) origin.Method Clinicopathological characteristics, perioperative data and survival outcomes in young patients, defined as being 50 years or less (n=23), performing CRS+HIPEC between June 2017 to June 2019 were reviewed and compared with older patients, defined as aged over 50 years (n=47).Results Compared with older patients, young patients were more likely to present with PM at the time of diagnosis (78.3% vs 51.1%, P=0.029) and exhibit a mucinous and signet-ring histology (60.9% vs 29.8%, P=0.013). The cancer-specific survival (CSS) after CRS+HIPEC in two groups are similar. On multivariate Cox regression, rectal origin (HR, 2.51, 95%CI, 1.11-5.67; P=0.027) and mucinous/signet adenocarcinoma (HR, 2.20, 95%CI, 1.02-4.74; P=0.044) were independent risk factors for poor CSS.Conclusion Younger patients (aged ≤50 years) with PM of CRC origin presented more often with synchronous PM than older patients. Although tend to exhibit a aggressive nature, they derive similar benefit from CRS+HIPEC as older patients.

Background: It is believed that selective lateral lymph node (LPN) dissection (LPND) with total mesorectal excision after preoperative chemoradiotherapy can reduce lateral compartment recurrence and improve survival in rectal cancer patients with LPN metastases. We evaluated the feasibility, optimal indications, and prognosis of LPND after preoperative chemoradiotherapy in patients with rectal cancer.Methods: This was a multicenter retrospective study which included patients with rectal cancer and clinical evidence of LPN metastases (n = 466) treated across three hospitals in China. The patients who underwent the combined procedure were categorized into chemoradiotherapy (n = 155) and non-chemoradiotherapy (n = 291) groups.Results: Preoperative chemoradiotherapy significantly prolonged surgical duration (300.7 vs. 277.4 min, P <0.001). In a multivariate logistic regression analysis, a post-chemoradiotherapy LPN short-axis diameter ≥7 mm and poor/mucinous/signet adenocarcinoma were independent risk factors for pathological LPN metastasis after chemoradiotherapy. Overall survival (P <0.001) and disease-free survival (P <0.001) were significantly worse in patients with LPN, which was however not an independent risk factor for survival after eliminating confounders. Multivariate prognostic analysis conducted in a subset of 40 patients with pathological LPN metastasis showed that distant metastasis, metastasis beyond the obturator or internal iliac region, and more than one LPN metastasis were independent predictor of poor overall survival.Conclusions: Chemoradiotherapy with the combined procedure is safe and feasible with acceptable morbidity. A post-chemoradiotherapy short-axis LPN diameter ≥7 mm and poor/mucinous/signet adenocarcinoma can predict pathological LPN metastasis after chemoradiotherapy. However, LPND should be carefully considered in patients with distant metastases, metastases beyond the obturator or internal iliac region, and multiple LPN involvement.

Background The impact of primary tumour location on the prognosis of patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rarely discussed, and the evidence is still limited.Methods Patients with PM arising from CRC treated with CRS and HIPEC at the China National Cancer Center and Huanxing Cancer Hospital between June 2017 and June 2019 were systematically reviewed. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analysed.Results A total of 70 patients were divided into two groups according to colonic or rectal origin (18 patients in the rectum group and 52 patients in the colon group). Patients with PM of colonic origin were more likely to develop grade 3-4 postoperative complications after CRS+HIPEC (38.9% vs 19.2%, P=0.094), but this difference was not statistically significant. Patients with colon cancer had a longer median overall survival (OS) than patients with rectal cancer (27.0 vs 15.0 months, P=0.011). On the multivariate analysis, independent prognostic factors of reduced OS were rectal origin (HR 2.03, 95% CI 1.02–4.24, P = 0.044) and incomplete cytoreduction (HR 2.33, 95% CI 1.05-5.28, P = 0.039).Conclusion CRS is an originally complex and potentially life-threatening procedure, and we suggest that the indications for CRS+HIPEC in patients with PM of rectal origin be more restrictive and cautious.