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Cytoreduction and heated intraperitoneal chemotherapy for colorectal cancer: Are we excluding patients who may benefit?
Author(s) -
Rivard Justin D.,
Mcconnell Yarrow J.,
Temple Walley J.,
Mack Lloyd A.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23446
Subject(s) - medicine , hyperthermic intraperitoneal chemotherapy , conventional pci , colorectal cancer , proportional hazards model , oncology , lymph node , surgery , chemotherapy , hazard ratio , survival analysis , pseudomyxoma peritonei , prospective cohort study , cancer , cytoreductive surgery , confidence interval , appendix , ovarian cancer , myocardial infarction , paleontology , biology
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly used to treat peritoneal carcinomatosis from colorectal cancer. It is still relatively unknown which poor prognostic factors to avoid in order to optimize patient selection for CRS + HIPEC. Methods Between February 2003 and October 2011, 68 consecutive colorectal cancer patients who underwent CRS + HIPEC with a complete cytoreduction were identified from a prospective database. Survival analysis was performed using the Kaplan–Meier method, with log rank testing of differences between groups. Multivariate analysis was conducted using Cox proportional hazard regression. Results Median follow‐up was 30.3 (range, 2–88) months amongst survivors. Patients with a peritoneal cancer index (PCI) of 10 or less showed improved survival over those with a PCI of 11 or higher ( P = 0.03). No difference in survival was seen for the other potentially poor prognostic variables including lymph node status, synchronous peritoneal disease, peri‐operative systemic chemotherapy, and rectal cancer primary. Conclusions A low PCI was associated with improved survival. Complete CRS + HIPEC appears to result in similar survival outcomes regardless of delivery of peri‐operative systemic chemotherapy. Rectal origin, lymph node status, and synchronous peritoneal disease should not be used as an absolute exclusion criteria for CRS + HIPEC based on current data. J. Surg. Oncol. 2014 109:104–109 . © 2013 Wiley Periodicals, Inc.