Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Peritoneal Surface Malignancies of Colonic Origin: A Consensus Statement

Esquivel, Jesús; Sticca, Robert P.; Sugarbaker, Paul H.; Levine, Edward A.; Yan, Tristan D.; Alexander, Richard B.; Baratti, Dario; Bartlett, David L.; Barone, Robert M.; Barrios, P.; Bieligk, Samuel; Bretcha-Boix, Pedro; Chang, C. K.; Chu, Francis; Chu, Quyen D.; Daniel, Steve; Bree, Eelco de; Deraco, Marcello; Domínguez-Parra, Luis Manuel; Élias, Dominique; Flynn, R.; Foster, Jason M.; Garofalo, Alfredo; Gilly, François Noël; Gléhen, Olivier; Gómez-Portilla, Alberto; González-Bayón, L.; González-Moreno, Santiago; Goodman, Martin; Gushchin, Vadim; Hanna, Nader; Hartmann, Jens; Harrison, Lawrence E.; Hoefer, R.; Kane, John M.; Kecmanović, Dragutin; Kelley, Scott T.; Kuhn, Joseph A.; Lamont, Jeffery; Lange, Julie R.; Li, B.; Loggie, Brian W.; Mahteme, Haile; Mann, Gary N.; Martin, Robert; Misih, R. A.; Moran, Brendan; Morris, David L.; Oñate‐Ocaña, Luis F.; Petrelli, Nicholas J.; Philippe, G.; Pingpank, James F.; Pitroff, A.; Piso, Pompiliu; Quinones, M.; Riley, Lee B.; Rutstein, Lisa A.; Saha, Suranjit Kumar; Alrawi, Sadir; Sardi, Armando; Schneebaum, Shlomo; Shen, Perry; Shibata, David; Spellman, J.; Stojadinovic, Alexander; Stewart, John H.; Torres-Melero, J; Tuttle, Todd M.; Verwaal, Victor J.; Villar, Jesús; Wilkinson, Neal; Younan, Rami; Zeh, Herbert J.; Zoetmulder, F.A.N.; Sebbag, Gilbert

doi:10.1245/s10434-006-9185-7

Cited by 379 publications

(55 citation statements)

References 7 publications

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“…Verwaal et al [23] found that an 8% mortality rate was associated with aggressive therapy. Therefore, aggressive approaches such as cytoreduction and HIPEC should proceed in centers where surgical oncologists are experienced in these procedures [24]. …”

Section: Discussionmentioning

confidence: 99%

Validation and Clinical Use of the Japanese Classification of Colorectal Carcinomatosis: Benefit of Surgical Cytoreduction Even without Hyperthermic Intraperitoneal Chemotherapy

et al. 2010

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Background: This study aimed to validate an easy to use practical classification of peritoneal metastasis arising from colorectal cancer. Patients and Methods: Data from 2,134 consecutive patients who underwent resection for colorectal cancer at a single institution were reviewed. Peritoneal metastasis was classified depending on extent into three groups (P1–P3). The macroscopic radical resection rates and survival of patients with colorectal cancer complicated with peritoneal metastasis were analyzed. Results: Of the 2,134 patients, 116 (5.4%) had peritoneal metastasis. Among them, 20 (17.2%) underwent macroscopic radical resection. Tumor location on the right side was associated with more extensive peritoneal metastasis (p = 0.010). Male gender (p = 0.0027), liver metastasis (p = 0.0021), and P3 peritoneal metastasis were independent risk factors for noncurative resection. The Cox proportional hazards model showed that gender (p = 0.031), operation period (p = 0.031), and macroscopic radical resection for colorectal cancer and peritoneal metastasis (p = 0.031) were independent prognostic factors. Conclusions: Being female with left colon cancer complicated with P1 or P2 peritoneal metastasis is a good indicator for macroscopic radical resection if liver metastasis is absent. The present classification helped to determine surgical indication for patients with colorectal cancer complicated with synchronous peritoneal metastasis in routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Validation and Clinical Use of the Japanese Classification of Colorectal Carcinomatosis: Benefit of Surgical Cytoreduction Even without Hyperthermic Intraperitoneal Chemotherapy

et al. 2010

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“…Recent developments in this technique have shown that the addition of hyperthermia (temperature around 40°C) furthermore improves the degree of cytotoxicity. Hyperthermic intraperitoneal chemotherapy with mitomycin C combined with cytoreductive surgery is therefore the preferred approach in most centers [26]. A recently performed randomized trial confirmed the improved survival of this approach compared to palliative surgery and systemic chemotherapy in patients without concomitant liver metastases [27].…”

Section: Peritoneal Carcinomatosismentioning

confidence: 99%

Resection of Colorectal Liver Metastases with Extrahepatic Disease

Haas

Wicherts

Adam³

2008

Dig Surg

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Extrahepatic disease in combination with colorectal liver metastases has long been considered an absolute contraindication for surgery. However, in many reported series, long-term survival is achieved in selected patients with concomitant extrahepatic disease as long as the resection of all metastatic sites is complete. Owing to these results, an increasing number of patients with advanced metastatic colorectal disease are now being referred for surgery. For patients with concomitant liver and lung metastases, sequential resection of both disease sites has proven to be safe, offering a 5-year survival rate of more than 30%. On the contrary, hepatectomy combined with resection of regional lymph node metastases can only provide long-term survival in case of pedicular lymph node involvement. Furthermore, control of the disease by preoperative chemotherapy appears to be crucial. For peritoneal carcinomatosis, aggressive treatment combining cytoreductive surgery and intraperitoneal chemotherapy can offer a chance of prolonged long-term survival to selected patients with limited peritoneal extension. In conclusion, resection of both intra- and extrahepatic colorectal metastases should be considered if resection of all metastatic sites can be complete and the disease is controlled by chemotherapy. Long-term survival in these patients with advanced disease could be achieved if they are managed by experienced multidisciplinary teams.

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“…However, the overall morbidity and mortality rates vary from 23 to 44% and from 0 to 12%, respectively [11] . Aggressive approaches such as cytoreduction with IPC might be used in expert centers in this field [16] . In the West, peritoneal surgeons currently evaluate the peritoneal cancer index [17] , with scores ranging from 0 to 39.…”

Section: Discussionmentioning

confidence: 99%

New Staging System for Colorectal Cancer Patients with Synchronous Peritoneal Metastasis in Accordance with the Japanese Classification of Colorectal Carcinoma: A Multi-Institutional Study

Noura

Ohue²,

Ito³

et al. 2015

Dig Surg

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Background: Peritoneal metastasis of colorectal cancer (CRC) is often discovered during initial surgery. The aim of this study is to propose a new staging system that could be used to help determine the management of CRC patients. Methods: We evaluated a total of 766 Stage IV CRC patients with synchronous peritoneal metastasis. According to the Japanese classification, we divided the peritoneal metastasis into P1, P2, and P3. We distinguished distant metastasis from liver metastasis and peritoneal metastasis. According to the Cox proportional hazard model, we constructed a new staging group. Results: According to a comparison of the R² statistics, the combination of liver metastasis and peritoneal metastasis was selected as the final variables. Next, we defined P1H(-) as Grade A, P2H(-) as Grade B, and other groups as Grade C. Our proposed new stage (Akaike Information Criteria [AIC] 7,338.82; concordance index [c-index] 0.644; R² 0.123) could thus divide the patients into different prognostic groups more clearly than the current Japanese classification (AIC 7,373.89; c-index 0.619; R² 0.097). Conclusion: Our proposed new staging system is very simple and easy for general surgeons to follow. This system is useful for determining the appropriate operative strategy for CRC patients with peritoneal metastasis and for estimating the patients' prognosis.

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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Peritoneal Surface Malignancies of Colonic Origin: A Consensus Statement

Cited by 379 publications

References 7 publications

Validation and Clinical Use of the Japanese Classification of Colorectal Carcinomatosis: Benefit of Surgical Cytoreduction Even without Hyperthermic Intraperitoneal Chemotherapy

Validation and Clinical Use of the Japanese Classification of Colorectal Carcinomatosis: Benefit of Surgical Cytoreduction Even without Hyperthermic Intraperitoneal Chemotherapy

Resection of Colorectal Liver Metastases with Extrahepatic Disease

New Staging System for Colorectal Cancer Patients with Synchronous Peritoneal Metastasis in Accordance with the Japanese Classification of Colorectal Carcinoma: A Multi-Institutional Study

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