Impact of ovarian metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy originating from appendiceal and colorectal cancer

Bignell, Mark; Mehta, Akash; Alves, Sue; Chandrakumaran, Kandiah; Dayal, Sanjeev; Mohamed, Faheez; Cecil, Tom; Moran, Brendan

doi:10.1111/codi.14057

Cited by 17 publications

(10 citation statements)

References 27 publications

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“…We found that 41.8% of female PMP patients had resection of both ovaries before being referred for CRS þ HIPEC. Bignell et al [29] found similar results with 36.3% of women having both ovaries resected at index surgery (prereferral).…”

Section: Umbilicusmentioning

confidence: 66%

Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Nors

Iversen

Nielsen

et al. 2022

European Journal of Surgical Oncology

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Section: Umbilicusmentioning

confidence: 66%

Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Nors

Iversen

Nielsen

et al. 2022

European Journal of Surgical Oncology

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“…Since ovarian lining and peritoneal lining are derived from the same embryological origins, the same results can be extrapolated to cases of ovarian metastases. And this has been confirmed in a study comparing PC patients with ovarian metastases undergoing CRS+HIPEC to PC patients without ovarian metastases undergoing CRS+HIPEC, wherein both groups showed similar survival rates [28]. Even the studies addressing CRS+HIPEC have stressed the need and significance of optimal cytoreduction to have a meaningful improvement in outcomes [29][30][31] while the role of HIPEC is still debated.…”

Section: Discussionmentioning

confidence: 93%

Ovarian Metastases of Colorectal Origin: Treatment Patterns and Factors Affecting Outcomes

Kammar

Engineer

Patil

et al. 2017

Indian J Surg Oncol

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The purpose of this study is to evaluate the patterns of treatment and factors affecting outcomes in ovarian metastases of colorectal origins treated at our institution and to assess the response of ovarian metastases to chemotherapy. Survival in R0 and R+ resections and patients receiving only chemotherapy is also analyzed. This is a retrospective study of 25 patients registered between January 2012 and December 2015. Patient's age, disease status, mode of presentation, disease spread, mode of treatment, response to chemotherapy, completeness of resection, histology, and outcomes were considered as variables for analysis. There were 21 synchronous presentations and 4 metachronous presentations. In synchronous presentations, only 2 had extra-abdominal disease. Of these patients, 15 underwent surgeries of various extents. The remaining 6 patients were treated with chemotherarpy initially. Only one of them could come up to surgery later. In R0 resections, disease recurred between 1 and 9 months (median 3.5 months). The recurrence was in peritoneum and ovaries. In operated cases, 12 of 15 patients received chemotherapy and 9 patients progressed on first line chemotherapy. In all 4 metachronous patients, the disease was in the peritoneum. No one underwent surgery for the recurrence due to the extensive nature of the disease. All received chemotherapy. Sixty-six percent ovarian metastases showed progression on chemotherapy. There was no significant difference in the median survival between patients treated with surgery plus chemotherapy (23 months) vs. those treated with chemotherapy alone (28 months). Age and presence of disease at other sites did not affect the outcomes. Non-signet ring cell histologies showed better outcomes compared to signet ring cell histology ( = 0.02). Synchronous presentation, R0 resections, and responsive disease showed better survival, however it was clinically not significant. Treatment of ovarian metastases of colorectal origins is varied but has consistently poor outcome. Non-signet histology was the only prognostic factor which showed better outcome. Survival was not different between patients treated with surgery+chemotherapy and chemotherapy alone but majority of ovarian metastases progressed on chemotherapy. Considering the poor response to chemotherapy and peritoneum being the most common site of disease, both in primary and recurrent setting, R0 resection should always be attempted after selecting the correct patients using PET scan, laparoscopy and standard exploratory protocols. Treatment should be tailored upon patient's status and disease burden with an aim to do complete cytoreduction whenever possible. CRS+HIPEC (cytoreductive surgery + hyperthermic intraperitoneal chemotherapy) can be considered on case to case basis as even R0 resections tend to recur.

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“…In contrast to traditional belief, the presence of ovarian metastases of colorectal cancer origin is no longer considered to be associated with decreased survival outcomes, provided that a complete cytoreduction is achieved and combined with HIPEC [37,38].…”

Section: Cytoreductive Surgery: "Complete Cytoreductive (Cc)" Scoring Systemmentioning

confidence: 97%

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Valente

Moran

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Peritoneal dissemination is a frequent occurrence in the natural history of colorectal cancer, which may be synchronous or metachronous.• The clinical benefit of systemic chemotherapy in patients with colorectal peritoneal metastases is less than in patients with other metastatic sites. • A substantial survival benefit, with some patients cured, can be achieved in selected patients undergoing CRS and HIPEC. • Outcome of CRS and HIPEC for colorectal peritoneal metastases is best in patients with low disease burden and complete cytoreduction. • Currently, a shift in focus is taking place from treatment of established colorectal peritoneal metastases to prevention and early detection, by identification of patients at high risk for developing colorectal peritoneal metastases. • Combining CRS and HIPEC with limited resection of liver metastases is feasible and achieves good oncological outcomes in a highly selected group of patients.

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Impact of ovarian metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy originating from appendiceal and colorectal cancer

Abstract: Women with ovarian metastases from low-grade appendiceal tumours or colorectal cancer treated with CRS and HIPEC have similar survival rates to patients without ovarian metastases. Long-term survival and cure is feasible in patients amenable to complete tumour removal.

Cited by 17 publications

References 27 publications

Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Ovarian Metastases of Colorectal Origin: Treatment Patterns and Factors Affecting Outcomes

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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