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

• Published in: Cancers Vol. 14; no. 16; p. 3978
• Main Authors: Herold, Zoltan, Acs, Miklos, Szasz, Attila Marcell, Olasz, Katalin, Hussong, Jana, Mayr, Max, Dank, Magdolna, Piso, Pompiliu
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 17-08-2022; MDPI
• Subjects: Adenocarcinoma; Cancer therapies; Chemotherapy; Colon; Colorectal carcinoma; Invasiveness; Metastases; Metastasis; Patients; Peritoneum; Statistical analysis; Surgery; Survival; Tumors
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14163978

Background: Mucinous adenocarcinoma is a frequent subtype in colorectal cancer (CRC). A higher initial T-stage, poorer differentiation, worse response to anti-tumor therapies, and shorter survival are characteristic of mucinous CRC. Moreover, the therapeutic benefit of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in mucinous CRC has not been significantly investigated. Methods: A retrospective analysis of 218 CRC patients with synchronous or metachronous peritoneal metastases was conducted. Results: 129 and 89 patients had synchronous and metachronous metastases, and 36 (27.8%) and 22 (24.8%) of these were mucinous CRC, respectively. Mucinous CRC was more frequent in the proximal colon, with a higher T-stage and N-stage and with an average peritoneal carcinomatosis index that was 2 values higher. Disease-specific survival was significantly worse in the synchronous mucinous group (median survival: 22.4 months vs. 36.3 months, p = 0.0229). In contrast, no such difference was observed in the metachronous cohort (32.6 months vs. 34.4 months, p = 0.6490). Conclusions: In the case of synchronous peritoneal metastases originating from mucinous CRC, the positive effect of CRS+HIPEC cannot be verified, and the added value of this highly invasive treatment is therefore somewhat questioned. However, CRS + HIPEC is recommended for metachronous metastases, since no difference between the two CRC-subtypes could be verified.