Survival Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Synchronous Versus Metachronous Onset of Peritoneal Metastases of Colorectal Carcinoma

Abstract

Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal metastases (PM) from colorectal carcinoma (CRC). Because of considerable morbidity, optimal patient selection is essential. This study was designed to determine the impact of the onset of PM (synchronous vs. metachronous) on survival outcomes after CRS-HIPEC. Methods Patients undergoing CRS-HIPEC for colorectal PM in two academic centers in the Netherlands between 2010 and 2020 were eligible for inclusion. Patients were classified as synchronous (s-PM, i.e., diagnosis at time of presentation, staging, or primary surgery) or metachronous onset (m-PM, i.e., diagnosis during follow-up) of colorectal PM. Survival outcomes were compared between groups by Kaplan–Meier survival and Cox regression analyses. Results Of 390 included patients, 179 (45.9%) had synchronous onset of colorectal PM. These patients more often presented with higher TN-stage and poor differentiation/signet cell histology. Treatment with perioperative chemotherapy was more common in s-PM patients. m-PM patients experienced more serious postoperative complications (Clavien-Dindo ≥ III). There was no significant difference in disease-free survival (DFS) between s-PM (median 9 months, interquartile range [IQR] 5–15) and m-PM patients (median 8 months, IQR 5–17). Overall survival (OS) was significantly shorter for s-PM (median 28 months, IQR 11–48) versus m-PM patients (median 33 months, IQR 18–66, p = 0.049). Synchronous onset of PM was not independently associated with OS in a multivariable analysis. Conclusions Synchronous onset of colorectal PM was associated with poor tumor characteristics and more advanced disease, but was not an independent predictor of survival outcomes after CRS-HIPEC.

Patients with Metachronous Peritoneal Metastatic Mucinous Colorectal Adenocarcinoma Benefit More from Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) than Their Synchronous Counterparts

“…Nonetheless, the current literature is lacking a similar mucinous adenocarcinoma-specific study; the present study aims to fill this gap. In a recent study by Dietz et al [ 46 ], the survival outcomes after CRS + HIPEC in synchronous versus metachronous PM of CRC have been compared. Consistent with the available results, they found that synchronous PM patients presented with higher TN-stages ( p < 0.001) and that mucinous adenocarcinomas were more common in this group ( p = 0.001).…”

“…Consistent with the available results, they found that synchronous PM patients presented with higher TN-stages ( p < 0.001) and that mucinous adenocarcinomas were more common in this group ( p = 0.001). Furthermore, OS was significantly shorter for synchronous PM compared to metachronous PM patients (28 versus 33 months, respectively, p = 0.045) [ 46 ]. We can draw the same conclusion in this regard—that synchronous peritoneal metastatic disease demonstrates poor tumor characteristics and a more advanced disease.…”

Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

“…It is estimated that approximately 6% of patients diagnosed with CRC have metastasis at the time of diagnosis. Of these patients, approximately 8% will have synchronous peritoneal involvement, while 20% will have liver metastasis [ 6 , 7 , 8 , 18 ]. The actual incidence of metachronous CRC metastasis is unknown but is estimated to be less than 10% based on a series.…”

“…Comparison of PCI values demonstrated that patients with the presence of SPM had a higher PCI (>20) (57 patients, 43.1%), while those with MPM had intermediate PCI values (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) (46 patients, 42.5%) (p = 0.014).…”

“…Kaplan-Meir estimation of OS at 36 months after diagnosis was 32% (median: 21 months; 95% CI: [16][17][18][19][20][21][22][23][24][25]. The results of the univariate survival analysis are shown in Table 2.…”