Extent of Colorectal Peritoneal Carcinomatosis: Attempt to Define a Threshold Above Which HIPEC Does Not Offer Survival Benefit: A Comparative Study

Background The main prognostic factors after complete cytoreductive surgery (CCRS) of colorectal peritoneal carcinomatosis (PC) followed by intraperitoneal chemotherapy (IPC) are completeness of the resection and extent of the disease. This study aimed to determine a threshold value above which CCRS...

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Bibliographic Details
Published in:	Annals of surgical oncology Vol. 22; no. 9; pp. 2958 - 2964
Main Authors:	Goéré, Diane, Souadka, Amine, Faron, Matthieu, Cloutier, Alexis S., Viana, Benjamin, Honoré, Charles, Dumont, Frédéric, Elias, Dominique
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-09-2015 Springer Nature B.V
Subjects:	Adult Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Chemotherapy, Cancer, Regional Perfusion - mortality Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Combined Modality Therapy Cytoreduction Surgical Procedures - mortality Female Follow-Up Studies Gastrointestinal Oncology Humans Hyperthermia, Induced - mortality Male Medicine Medicine & Public Health Middle Aged Neoplasm Staging Oncology Peritoneal Neoplasms - mortality Peritoneal Neoplasms - secondary Peritoneal Neoplasms - therapy Prognosis Prospective Studies Surgery Surgical Oncology Survival Rate Young Adult Peritoneal Cancer Index Complete Cytoreduction Overall Survival Peritoneal Carcinomatosis Curative Group
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Summary:	Background The main prognostic factors after complete cytoreductive surgery (CCRS) of colorectal peritoneal carcinomatosis (PC) followed by intraperitoneal chemotherapy (IPC) are completeness of the resection and extent of the disease. This study aimed to determine a threshold value above which CCRS plus IPC may not offer survival benefit compared with systemic chemotherapy. Methods Between March 2000 and May 2010, 180 patients underwent surgery for PC from colorectal cancer with intended performance of CCRS plus IPC. Results Among the 180 patients, CCRS plus IPC could be performed for 139 patients (curative group, 77 %), whereas it could not be performed for 41 patients (palliative group, 23 %). The two groups were comparable in terms of age, gender, primary tumor characteristics, and pre- and postoperative systemic chemotherapy. The mean peritoneal cancer index (PCI) was lower in the curative group (11 ± 7) than in the palliative group (23 ± 7) ( p < 0.0001). After a median follow-up period of 60 months (range 47–74 months), the 3-year overall survival (OS) rate was 52 % [95 % confidence interval (CI) 43–61 %] in the curative group compared with 7 % (95 % CI 2–25 %) in the palliative group. Comparison of the survivals for each PCI (ranging from 5 to 36) shows that OS did not differ significantly between the two groups of patients when the PCI was higher than 17 (hazard ratio 0.64; range 0.38–1.09). Conclusion This study confirmed the major prognostic impact of PC extent. When the PCI exceeds 17 in PC of colorectal origin, CCRS plus IPC does not seem to offer any survival benefit.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1068-9265 1534-4681
DOI:	10.1245/s10434-015-4387-5