Clinical outcomes of complete cytoreduction with concurrent liver resection followed by hyperthermic intraperitoneal chemotherapy for synchronous peritoneal and liver metastatic colorectal cancer

Abstract

BackgroundThis study aimed to evaluate the clinical outcomes of concurrent liver resection with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer patients with synchronous liver and peritoneal metastases.MethodsPatients with colorectal liver and peritoneal metastasis who underwent complete cytoreduction and hyperthermic intraperitoneal chemotherapy with concurrent liver surgery between September 2014 and July 2018 were included. Perioperative outcomes, overall survival, and progression-free survival were analyzed retrospectively.ResultsIn total, 22 patients were included. The median peritoneal cancer index was 13 (range, 0–26), and the median number of liver metastases was 3 (range, 1–13). The mean total operative time was 11.4 ± 2.6 h. Minor postoperative complications (Clavien-Dindo grade I–II) were reported in 10 patients (45.5%), and major postoperative complications (grade III–V) were reported in five patients (22.7%), including one mortality patient. The median overall survival since diagnosis with metastasis was 27.4 months. The median overall survival since surgical intervention and the progression-free survival were 16.7 months and 7.1 months, respectively.ConclusionsThis short-term follow-up study showed that, in an experienced center, combined resection with hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases was feasible and safe with acceptable oncologic outcomes.

Synchronous liver and peritoneal metastases from colorectal cancer: Is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with liver resection a feasible option?

“…However, no data were available to clarify the risk factors to determine the difference in morbidity. Our results are in line with the findings of Cloyd et al ( 35 ), who described that concomitant LR and CRS/HIPEC were associated with an increased number of postoperative complications and increased readmission compared to patients undergoing CRS/HIPEC alone. However, contradictory results of single-institution studies reporting no difference in postoperative morbidity have been published ( 3 , 23 , 27 , 33 ).…”

“…In most of the studies, the PCI was comparable, and in all cases, it was below 20, which corresponds with clinical guidelines ( Table 2 ). With the exception of the studies by Pinto et al ( 28 ), Lo Dico et al ( 40 ), and Jeon et al ( 35 ), the studies in this review presented patients treated in a one-step procedure with CRS–HIPEC and liver resection/ablation performed during the same surgical procedure. Only a few studies reported the number of liver lesions.…”

Outcomes of Combined Peritoneal and Local Treatment for Patients with Peritoneal and Limited Liver Metastases of Colorectal Origin: A Systematic Review and Meta-Analysis

“…In total, 3137 patients participated in 2 case-control studies, 11 prospective studies, and 7 retrospective cohort studies. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] No randomized studies were identified. Although the search and selection process was designed to include various oligometastatic sites, the studies that met the criteria for inclusion all presented liver metastases.…”

Tolerability on Serious Adverse Events of First-Line Bevacizumab and Cetuximab for RAS Wild-Type Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

“…Moreover, about 25% of patients diagnosed with localized CRC are at elevated risk for metastatic progression in the later course of the disease. In Korea, approximately 15–25% of the patients show synchronous metastases and 30–40% of them have unresectable liver metastasis [ 2 ]. Ultimately, 50–60% of patients present with mCRC, including recurrent metachronous CRC [ 3 ].…”