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Prognostic factors influencing survival in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated colorectal peritoneal metastases: a systematic review and meta‐analysis
Author(s) -
Narasimhan V.,
Tan S.,
Kong J.,
Pham T.,
Michael M.,
Ramsay R.,
Warrier S.,
Heriot A.
Publication year - 2020
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.15003
Subject(s) - medicine , hyperthermic intraperitoneal chemotherapy , colorectal cancer , oncology , hazard ratio , perioperative , conventional pci , survival analysis , cytoreductive surgery , lymph node , chemotherapy , oxaliplatin , surgery , gastroenterology , cancer , confidence interval , ovarian cancer , myocardial infarction
Aim Peritoneal metastases from colorectal cancer confer the worst survival among all metastatic sites. The adoption of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can offer selected patients with isolated colorectal peritoneal metastases (CRPM) a favourable long‐term survival. There are numerous factors postulated to influence survival in patients undergoing CRS and HIPEC. The aim of this study was to identify the key perioperative prognostic factors that influence survival in patients undergoing CRS and HIPEC for isolated CRPM. Method A systematic review and meta‐analysis were conducted to evaluate prognostic factors influencing survival in patients undergoing CRS and HIPEC for isolated CRPM. Results Thirty‐three studies fitted the inclusion criteria for the systematic review, with 25 studies included in the meta‐analysis. On pooled analysis, incomplete cytoreduction, increasing peritoneal carcinoma index (PCI) and lymph node involvement were significantly associated with a worse survival. Additionally, a rectal primary [hazard ratio (HR) 1.93, 95% CI 1.10–3.37], adjuvant chemotherapy (HR 0.71, 95% CI 0.54–0.93) and perioperative grade III/IV morbidity (HR 1.59, 95% CI 1.17–2.16) were also found to significantly influence survival. Notably, tumour differentiation and signet ring cell histology did not influence survival on pooled analysis. Conclusion This meta‐analysis confirms that in patients undergoing CRS and HIPEC for isolated CRPM, incomplete cytoreduction, high PCI and lymph node involvement have a negative influence on survival. In addition, a rectal primary, adjuvant chemotherapy use and grade III/IV morbidity are important factors that also significantly influence survival.