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

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

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 outcome...

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Published in:Journal of surgical oncology Vol. 119; no. 3; pp. 336 - 346
Main Authors: Alzahrani, Nayef A., Valle, Sarah J., Fisher, Oliver M., Sugarbaker, Paul H., Yonemura, Yutaka, Glehen, Olivier, Goere, Dianne, Honore, Charles, Brigand, Cecile, Hingh, Ignace, Verwaal, Vic J., Deraco, Marcello, Baratti, Dario, Kusamura, Shigeki, Pocard, Mark, Piso, Pompiliu, Maerz, Loreen, Marchal, Frederic, Moran, Brendan, Levine, Edward A., Dumont, Frédéric, Pezet, Denis, Abboud, Karine, Kozman, Mathew A., Liauw, Winston, Morris, David L.
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01-03-2019
Wiley-Blackwell
Subjects:
Bacteriology
Biochemistry, Molecular Biology
Cancer surgery
Chemotherapy
Colorectal cancer
colorectal peritoneal carcinomatosis (CRPC)
Gastric cancer
hyperthermic intraperitoneal chemotherapy (HIPEC)
iterative cytoreductive surgery (iCRS)
Life Sciences
Medical prognosis
Microbiology and Parasitology
Molecular biology
Morbidity
Mortality
prognostic factors
survival
colorectal peritoneal carcinomatosis (CRPC)
hyperthermic intraperitoneal chemotherapy (HIPEC)
prognostic factors
iterative cytoreductive surgery (iCRS)
survival
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Summary: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.
Bibliography:Nayef A. Alzahrani and Sarah J. Valle contributed equally as first authors.
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ISSN:0022-4790
1096-9098
DOI:10.1002/jso.25277