Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: A systematic review

Oudheusden, Thijs R. van; Nienhuijs, Simon W.; Luyer, Misha; Nieuwenhuijzen, Grard A. P.; Lemmens, Valery; Rutten, H.J.T.; Hingh, Ignace H. J. T. de

doi:10.1016/j.ejso.2015.05.018

Cited by 38 publications

(35 citation statements)

References 60 publications

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“…Als Entscheidungshilfe dient der PCI (peritoneal cancer index) [1215]. Rezidive sind nach zytoreduktiver Therapie und intraperitonealer Chemotherapie häufig und gelten als ungünstige prognostische Faktoren [1216].…”

Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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“…Disease recurrence has been described in 48% to 82% of patients at a median interval of 6 to 12 months after the initial CRS with a locoregional recurrence rate of 73% . In this study, the median RFS after the initial CRS was 15.0 months and 10.1 months after the iCRS.…”

Section: Discussionmentioning

confidence: 55%

“…Experienced centers approach recurrent disease in a variety of ways with iCRS±HIPEC±systemic chemotherapy in selected patients. Several small series have reported treatment of peritoneal recurrences after CRS/HIPEC with a varying median survival of 20 to 56 months and 3‐year survival of 0% to 66% . Unfortunately, a clear evaluation of outcomes has been precluded by a heterogeneous cohort in some series and non‐CRS/HIPEC procedures in others …”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17][18] Prognostic factors for survival after the CRS/HIPEC include a low peritoneal carcinomatosis index (PCI), complete cytoreduction (CC0), and favorable tumor histology, and consequently these factors have historically refined patient selection for CRS/HIPEC. Recurrence after CRS/HIPEC is common, occurring in up to 80% of patients with CPM, 19,20 with peritoneal being the most common site. [19][20][21] The median time to recurrence after CRS/HIPEC was previously reported to be 33 months.…”

Section: Introductionmentioning

confidence: 99%

“…Recurrence after CRS/HIPEC is common, occurring in up to 80% of patients with CPM, 19,20 with peritoneal being the most common site. [19][20][21] The median time to recurrence after CRS/HIPEC was previously reported to be 33 months. 22 The management of recurrent CPM and whether iterative CRS (iCRS) is feasible in these patients is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience

Alzahrani

Valle

Fisher

et al. 2018

Journal of Surgical Oncology

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Background and Objectives The aims of this multi‐institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. Methods Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. Results The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high‐grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence‐free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5‐year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11‐20; P < 0.001 for PCI > 20), high‐grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). Conclusion iCRS can provide long‐term survival benefits to highly selected colorectal peritoneal carcinomatosis patients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.

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Adjuvant Systemic Chemotherapy vs Active Surveillance Following Up-front Resection of Isolated Synchronous Colorectal Peritoneal Metastases

et al. 2020

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IMPORTANCE To date, there are no data on the value of adjuvant systemic chemotherapy following up-front resection of isolated synchronous colorectal peritoneal metastases.OBJECTIVE To assess the association between adjuvant systemic chemotherapy and overall survival following up-front resection of isolated synchronous colorectal peritoneal metastases. DESIGN, SETTING, AND PARTICIPANTSIn this population-based, observational cohort study using nationwide data from the Netherlands Cancer Registry (diagnoses between January 1, 2005, and December 31, 2017; follow-up until January 31, 2019), 393 patients with isolated synchronous colorectal peritoneal metastases who were alive 3 months after up-front complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy were included. Patients allocated to the adjuvant systemic chemotherapy group were matched (1:1) with those allocated to the active surveillance group by propensity scores based on patient-, tumor-, and treatment-level covariates.EXPOSURES Adjuvant systemic chemotherapy, defined as systemic chemotherapy without targeted therapy, starting within 3 months postoperatively. MAIN OUTCOMES AND MEASURESOverall survival was compared between matched groups using Cox proportional hazards regression analysis adjusted for residual imbalance. A landmark analysis was performed by excluding patients who died within 6 months postoperatively. A sensitivity analysis was performed to adjust for unmeasured confounding by major postoperative morbidity. RESULTSOf 393 patients (mean [SD] age, 61 [10] years; 181 [46%] men), 172 patients (44%) were allocated to the adjuvant systemic chemotherapy group. After propensity score matching of 142 patients in the adjuvant systemic chemotherapy group with 142 patients in the active surveillance group, adjuvant systemic chemotherapy was associated with improved overall survival compared with active surveillance (median, 39.2 [interquartile range, 21.1-111.1] months vs 24.8 [interquartile range, 15.0-58.4] months; adjusted hazard ratio [aHR], 0.66; 95% CI, 0.49-0.88; P = .006), which remained consistent after excluding patients who died within 6 months postoperatively (aHR, 0.68; 95% CI, 0.50-0.93; P = .02) and after adjustment for major postoperative morbidity (aHR, 0.71; 95% CI, 0.53-0.95). CONCLUSIONS AND RELEVANCEFindings of this study suggest that in patients undergoing up-front resection of isolated synchronous colorectal peritoneal metastases, adjuvant systemic chemotherapy appeared to be associated with improved overall survival. Although randomized trials are needed to address the influence of potential residual confounding and allocation bias on this association, results of this study may be used for clinical decision-making in this patient group for whom no data are available.

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Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer: A systematic review

Cited by 38 publications

References 60 publications

S3-Leitlinie – Kolorektales Karzinom

S3-Leitlinie – Kolorektales Karzinom

Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience

Adjuvant Systemic Chemotherapy vs Active Surveillance Following Up-front Resection of Isolated Synchronous Colorectal Peritoneal Metastases

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