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Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience
Author(s) -
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.
Publication year - 2019
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.25277
Subject(s) - medicine , hyperthermic intraperitoneal chemotherapy , conventional pci , surgery , colorectal cancer , chemotherapy , cytoreductive surgery , peritoneal carcinomatosis , oncology , gastroenterology , cancer , myocardial infarction , ovarian cancer
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.