Cytoreduction plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in colorectal cancer patients: a single-center cohort study

• Published in: World journal of surgical oncology Vol. 17; no. 1; p. 58
• Main Authors: Solaini, Leonardo, D'Acapito, Fabrizio, Passardi, Alessandro, Framarini, Massimo, Tauceri, Francesca, Di Pietrantonio, Daniela, Frassineti, Giovanni Luca, Casadei Gardini, Andrea, Cucchetti, Alessandro, Cavaliere, Davide, Ercolani, Giorgio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27-03-2019; BioMed Central; BMC
• Subjects: Age; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Cancer; Cancer patients; Cancer research; Cancer treatment; Cardiac patients; Care and treatment; Chemotherapy; Cohort analysis; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy - methods; Complications; Cytoreduction; Cytoreduction Surgical Procedures; Debulking; Disease-Free Survival; Female; Gastric cancer; Humans; Hyperthermia, Induced; Hyperthermic intraperitoneal chemotherapy; Lymphatic Metastasis - pathology; Male; Medical prognosis; Middle Aged; Multivariate analysis; Organs; Outcome; Patients; Peritoneal carcinomatosis; Peritoneal diseases; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Peritoneum; Postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prognosis; Regression analysis; Retrospective Studies; Studies; Surgery; Survival; Systematic review; Cytoreduction; Hyperthermic intraperitoneal chemotherapy; Outcome; Colorectal cancer; Peritoneal carcinomatosis
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-019-1602-z

In this study, we report our experience of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC), focusing on the factors affecting survival.
All patients with surgically treated PC from colorectal cancer and with no involvement of other organs referred to our institute from March 2005 to December 2017 were included in the analysis.
Thirty-eight patients underwent CRS-HIPEC, and all had a completeness of cytoreduction score of 0 (CC0). The median operating time was 645 min (interquartile range [IQR] 565-710). Five patients (13.1%) had Clavien-Dindo grade > 2 postoperative complications. Median overall survival (OS) was 60 months. In the Cox regression for OS, calculated on the CRS-HIPEC group, the peritoneal cancer index (PCI) > 6 (hazard ratio [HR] 4.48, IQR 1.68-11.9, P = 0.003) and significant nodal involvement (N2) (HR 3.89, IQR 1.50-10.1, P = 0.005) were independent prognostic factors. Median disease-free survival (DFS) was 16 months. Only N2 (HR 2.44, IQR 1.11-5.36, P = 0.027) was a significantly negative prognostic factor for DFS in multivariate analysis.
CRS-HIPEC can substantially improve survival. However, patients with high PCI (PCI > 6) and significant nodal involvement (N2) may not benefit from the procedure.