Cytoreduction plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in colorectal cancer patients: a single-center cohort study

Abstract

Background In this study, we report our experience of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC), focusing on the factors affecting survival. Methods All patients with surgically treated PC from colorectal cancer and with no involvement of other organs referred to our institute from March 2005 to December 2017 were included in the analysis. Results Thirty-eight patients underwent CRS-HIPEC, and all had a completeness of cytoreduction score of 0 (CC0). The median operating time was 645 min (interquartile range [IQR] 565–710). Five patients (13.1%) had Clavien-Dindo grade > 2 postoperative complications. Median overall survival (OS) was 60 months. In the Cox regression for OS, calculated on the CRS-HIPEC group, the peritoneal cancer index (PCI) > 6 (hazard ratio [HR] 4.48, IQR 1.68–11.9, P = 0.003) and significant nodal involvement (N2) (HR 3.89, IQR 1.50–10.1, P = 0.005) were independent prognostic factors. Median disease-free survival (DFS) was 16 months. Only N2 (HR 2.44, IQR 1.11–5.36, P = 0.027) was a significantly negative prognostic factor for DFS in multivariate analysis. Conclusions CRS-HIPEC can substantially improve survival. However, patients with high PCI (PCI > 6) and significant nodal involvement (N2) may not benefit from the procedure.

Does Primary Tumour Location Affect the Prognosis of Patients with Colorectal Cancer Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy?

“…Close attention has been given to the morbidity and mortality associated with the CRS + HIPEC procedure. Our institution con rmed that the grade 3-4 morbidity rate and mortality rate after CRS + HIPEC were 24.3% and 0%, respectively, which is basically consistent with the results reported by international centres [7,[23][24][25][26] . Notably, we also found that patients with PM of rectal origin were more likely to develop grade 3-4 postoperative complications after CRS + HIPEC than patients with PM of colonic origin (38.9% vs 19.2%, P = 0.094), but this difference was not statistically signi cant.…”

“…At present, most literature has demonstrated that a high peritoneal cancer index (PCI), incomplete cytoreduction, young age and postoperative complications are poor prognostic factors after CRS + HIPEC [9][10][11][12] . It has been well established that different primary tumour locations have different biological behaviours and prognoses [13] .…”

Diagnostic value of diffusion-weighted imaging/magnetic resonance imaging for peritoneal metastasis from malignant tumor

“…[ 5 – 7 ] This is especially important for small lesions that are difficult to detect by CT, conventional MRI, and PET-CT. [ 9 ] Patients detected with PMs might benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. [ 26 , 27 ] The present meta-analysis revealed that DWI had 89% pooled sensitivity (95% CI: 83%–93%) and 86% pooled specificity (95% CI: 79%–91%) for the diagnosis of PMs from various abdominal cancers.…”

Mid-Term Audit of a National Peritoneal Surface Malignancy Program Implementation in a Low Middle Income Country: The Moroccan Experience

“…As can be concluded from the intersection of the aforementioned studies, the completeness of cytoreduction, surgeon experience and center expertise are the common key elements to survival benefit regardless of tumor origin. Therefore, developing proficiency in PSM surgery is the most crucial step in implementing a CRS and HIPEC specialized program [ 25 ].…”