Effect of hyperthermic intraperitoneal chemotherapy in combination with cytoreductive surgery on the prognosis of patients with colorectal cancer peritoneal metastasis: a systematic review and meta-analysis

Abstract

Background Peritoneal metastasis often occurs in patients with colorectal cancer peritoneal metastasis, and the prognosis is poor. A large body of evidence highlights the beneficial effects of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on survival, but to date, there is little consensus on the optimal treatment strategy for patients with colorectal cancer peritoneal metastasis. The purpose of this study is to evaluate the impact of CRS + HIPEC on survival and provide reference for the treatment of patients with colorectal cancer peritoneal metastasis. Methods This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The PubMed, Embase, Cochrane, Web of Knowledge, and ClinicalTrials.gov databases were screened from inception of the review to March 11, 2022. Ten studies were included in qualitative and quantitative analysis. Results A total of 3200 patients were enrolled in the study, including 788 patients in the CRS and HIPEC groups and 2412 patients in the control group, of which 3 were randomized controlled trials and 7 were cohort studies. The 3 randomized controlled studies were of high quality, and the quality scores of the 7 cohort studies were all 7 or above, indicating high quality. The results showed that the OS of CRS + HIPEC group was higher than that of control group (HR: 0.53, 95% CI: 0.38–0.73; P < 0.00001, I2 = 82.9%); the heterogeneity of the studies was large. The subgroup analysis showed that the OS of CRS and HIPEC group was higher than that of PC group (HR: 0.37, 95% CI: 0.30–0.47; P = 0.215, I2 = 31%) and higher than that in CRS group (HR: 0.73, 95% CI: 0.49–1.07; P = 0.163, I2 = 44.8%); the heterogeneity of the studies was low. In the OPEN group, the OS of THE CRS and HIPEC groups was higher than that in the control group (HR: 0.51, 95% CI: 0.38–0.70; P = 0.353, I2 = 3.9%); OPEN group showed lower heterogeneity. The OS of 60–100-min group was higher than that in the control group (HR: 0.65, 95% CI: 0.49–0.88; P = 0.172, I2 = 37.4%); the heterogeneity of the studies was low. Sensitivity analysis showed that there was no significant difference in the results of the combined analysis after each study was deleted. The results of publication bias showed that the P-value of Egger and Begg tests was 0.078 > 0.05, indicating that there is no publication bias. Conclusions CRS + HIPEC can improve the survival rate of patients with colorectal cancer peritoneal metastasis

Repeat cytoreductive surgery with HIPEC for colorectal peritoneal metastases: a systematic review

“…The addition of HIPEC during CRS has recently been challenged by a randomised phase III trial, but nonetheless is commonly used to target this residual disease. Patients with CRPM are now experiencing dramatically improved survival following initial CRS and HIPEC, over 50% remaining alive after 3 years post operatively [ 8 , 36 ]. When combined with estimates that the global burden of CRC will increase by 63% over the coming two decades, it is expected that an increasing number of patients will live long enough to develop disease recurrence despite the use of adjuvant chemotherapy [ 1 ].…”

Diffuse malignant peritoneal mesothelioma: A review

“…With a median OS of 38.4 to 63.2 months, a five-year survival rate of 39.0% to 91.3%, and a perioperative mortality rate of 0 to 6%, the death risk among the patients with serious adverse events in the perioperative period is more than twice that of the patients without serious adverse events. Effective management, including preoperative, intraoperative, and postoperative management, in the perioperative period for the combined CRS and HIPEC might effectively reduce perioperative mortality (Table 2) (31)(32)(33). The combined CRS and HIPEC treatment strategy can completely resect the visible tumor, which can be seen with the naked eye.…”

“…The adverse events of combined CRS and HIPEC mainly include pulmonary infection, biliary leakage, abdominal abscess, deep vein thrombosis, anastomotic leakage, congestive heart failure, intestinal leakage, intestinal obstruction, incision dehiscence, hematological toxicity, cerebral infarction, pleural effusion, and moderate to severe hypoalbuminemia. These adverse events are correlated with the duration of surgery, PCI score, number of anastomoses, and organs or peritoneum resected (33). The adverse events are graded based on the PSOGI study (6) and consist of 48 adverse events, which are divided into 9 categories; each of which is classified as grade I-V. Grade I adverse events do not require intervention; grade II adverse events require drug therapy; grade III adverse events can be cured by conservative treatment and usually require intervention by auxiliary examinations, such as imaging; grade IV adverse events require intervention in the operation theater; and grade V adverse events are the patients' deaths.…”