Perioperative and Oncological Outcomes of Combined Hepatectomy with Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Metastatic Colorectal Cancer.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
08
06
2020
accepted:
31
08
2020
pubmed:
25
9
2020
medline:
18
5
2021
entrez:
24
9
2020
Statut:
ppublish
Résumé
Synchronous peritoneal and liver metastasis in colorectal cancer is a relative contraindication for curative surgery. We aimed to evaluate the safety and oncological outcomes of combined treatment of peritoneal and liver metastasis. We conducted a retrospective analysis of metastatic colorectal cancer patients from two prospective databases: peritoneal surface malignancy (n = 536) and hepatobiliary (n = 286). We compared 60 patients treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) and hepatectomy; 80 patients treated with cytoreduction and HIPEC only; and 63 patients treated with hepatectomy alone. No differences in demographics were observed between the groups. Median hospital and intensive care unit (ICU) stay was shorter in group C (7 and 1 days, respectively) versus groups A and B (13 and 1 days, and 12 and 1 days, respectively; p < 0.001). Postoperative complications were not significantly different. Median follow-up was 18.6, 23.1, and 30.6 months for groups A, B, and C, respectively. Estimated 5-year overall survival (OS) was 48.8% (group A), 55.4% (group B), and 60.2% (group C) [p = 0.043 for group A vs. group C], and estimated 5-year disease-free survival (DFS) was 14.2% (group A), 23.0% (group B), and 18.6% (group C). Five-year OS was superior in group C compared with group A (p = 0.043), and DFS was superior in group C compared with groups A and B (p = 0.043 and 0.03, respectively). The peritoneum was the site of first recurrence in groups A and B (23.3% and 32.5%, respectively), and the liver was the site of first recurrence in group C (44.4%). We report favorable perioperative and oncological outcomes in combined cytoreduction/HIPEC and hepatectomy for patients with peritoneal and liver metastasis. Surgical intervention after multidisciplinary discussion should be considered in patients with both peritoneal and hepatic lesions when complete cytoreduction is feasible.
Sections du résumé
BACKGROUND
BACKGROUND
Synchronous peritoneal and liver metastasis in colorectal cancer is a relative contraindication for curative surgery. We aimed to evaluate the safety and oncological outcomes of combined treatment of peritoneal and liver metastasis.
METHODS
METHODS
We conducted a retrospective analysis of metastatic colorectal cancer patients from two prospective databases: peritoneal surface malignancy (n = 536) and hepatobiliary (n = 286). We compared 60 patients treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) and hepatectomy; 80 patients treated with cytoreduction and HIPEC only; and 63 patients treated with hepatectomy alone.
RESULTS
RESULTS
No differences in demographics were observed between the groups. Median hospital and intensive care unit (ICU) stay was shorter in group C (7 and 1 days, respectively) versus groups A and B (13 and 1 days, and 12 and 1 days, respectively; p < 0.001). Postoperative complications were not significantly different. Median follow-up was 18.6, 23.1, and 30.6 months for groups A, B, and C, respectively. Estimated 5-year overall survival (OS) was 48.8% (group A), 55.4% (group B), and 60.2% (group C) [p = 0.043 for group A vs. group C], and estimated 5-year disease-free survival (DFS) was 14.2% (group A), 23.0% (group B), and 18.6% (group C). Five-year OS was superior in group C compared with group A (p = 0.043), and DFS was superior in group C compared with groups A and B (p = 0.043 and 0.03, respectively). The peritoneum was the site of first recurrence in groups A and B (23.3% and 32.5%, respectively), and the liver was the site of first recurrence in group C (44.4%).
CONCLUSIONS
CONCLUSIONS
We report favorable perioperative and oncological outcomes in combined cytoreduction/HIPEC and hepatectomy for patients with peritoneal and liver metastasis. Surgical intervention after multidisciplinary discussion should be considered in patients with both peritoneal and hepatic lesions when complete cytoreduction is feasible.
Identifiants
pubmed: 32968959
doi: 10.1245/s10434-020-09165-3
pii: 10.1245/s10434-020-09165-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3320-3329Commentaires et corrections
Type : CommentIn
Type : CommentIn
Références
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108. https://doi.org/10.3322/caac.21262
doi: 10.3322/caac.21262
pubmed: 25651787
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. https://doi.org/10.3322/caac.21590
doi: 10.3322/caac.21590
pubmed: 31912902
Riihimäki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep. 2016;6(1):29765. https://doi.org/10.1038/srep29765
doi: 10.1038/srep29765
pubmed: 27416752
pmcid: 4945942
Holch JW, Demmer M, Lamersdorf C, et al. Pattern and dynamics of distant metastases in metastatic colorectal cancer. Visc Med. 2017;33(1):70–5. https://doi.org/10.1159/000454687
doi: 10.1159/000454687
pubmed: 28612020
pmcid: 5465778
Arakawa K, Kawai K, Ishihara S, et al. Prognostic significance of peritoneal metastasis in stage IV colorectal cancer patients with R0 resection. Dis Colon Rectum. 2017;60(10):1041–9. https://doi.org/10.1097/dcr.0000000000000858
doi: 10.1097/DCR.0000000000000858
pubmed: 28891847
Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17(12):1709–19. https://doi.org/10.1016/s1470-2045(16)30500-9
doi: 10.1016/S1470-2045(16)30500-9
pubmed: 27743922
Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89(12):1545–50. https://doi.org/10.1046/j.1365-2168.2002.02274.x
doi: 10.1046/j.1365-2168.2002.02274.x
pubmed: 12445064
Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358–63. https://doi.org/10.1002/(sici)1097-0142(20000115)88:2%3c358::aid-cncr16%3e3.0.co;2-o
doi: 10.1002/(sici)1097-0142(20000115)88:2<358::aid-cncr16>3.0.co;2-o
pubmed: 10640968
Sanoff HK, Sargent DJ, Campbell ME, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26(35):5721–7. https://doi.org/10.1200/jco.2008.17.7147
doi: 10.1200/JCO.2008.17.7147
pubmed: 19001325
pmcid: 2645101
Renouf DJ, Lim HJ, Speers C, et al. Survival for metastatic colorectal cancer in the bevacizumab era: a population-based analysis. Clin Colorectal Cancer. 2011;10(2):97–101. https://doi.org/10.1016/j.clcc.2011.03.004
doi: 10.1016/j.clcc.2011.03.004
pubmed: 21859560
Jawed I, Wilkerson J, Prasad V, Duffy AG, Fojo T. Colorectal cancer survival gains and novel treatment regimens: a systematic review and analysis. JAMA Oncol. 2015;1(6):787–95. https://doi.org/10.1001/jamaoncol.2015.1790
doi: 10.1001/jamaoncol.2015.1790
pubmed: 26181239
Abdalla EK, Vauthey J-N, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239(6):818–25; discussion 825–7. https://doi.org/10.1097/01.sla.0000128305.90650.71
doi: 10.1097/01.sla.0000128305.90650.71
pubmed: 15166961
pmcid: 1356290
Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery. 1986;100(2):278–84.
pubmed: 3526605
Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases—a population-based study on incidence, management and survival. BMC Cancer. 2018;18(1):78. https://doi.org/10.1186/s12885-017-3925-x
doi: 10.1186/s12885-017-3925-x
pubmed: 29334918
pmcid: 5769309
Primrose JN. Surgery for colorectal liver metastases. Br J Cancer. 2010;102(9):1313–8. https://doi.org/10.1038/sj.bjc.6605659
doi: 10.1038/sj.bjc.6605659
pubmed: 20424612
pmcid: 2865767
Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 1998;14(3):254–61. https://doi.org/10.1002/(sici)1098-2388(199804/05)14:3%3c254::aid-ssu10%3e3.0.co;2-u
doi: 10.1002/(sici)1098-2388(199804/05)14:3<254::aid-ssu10>3.0.co;2-u
pubmed: 9548609
Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284–92. https://doi.org/10.1200/jco.2004.10.012
doi: 10.1200/JCO.2004.10.012
pubmed: 15310771
Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737–43. https://doi.org/10.1200/jco.2003.04.187
doi: 10.1200/JCO.2003.04.187
pubmed: 14551293
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32. https://doi.org/10.1245/s10434-008-9966-2
doi: 10.1245/s10434-008-9966-2
pubmed: 18521686
Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27(5):681–5. https://doi.org/10.1200/jco.2008.19.7160
doi: 10.1200/JCO.2008.19.7160
pubmed: 19103728
Cavaliere F, Valle M, De Simone M, et al. 120 peritoneal carcinomatoses from colorectal cancer treated with peritonectomy and intra-abdominal chemohyperthermia: a S.I.T.I.L.O. multicentric study. In Vivo. 2006;20(6A):747–50.
pubmed: 17203760
Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42.
doi: 10.1097/00000658-199501000-00004
Sugarbaker PH. Patient selection and treatment of peritoneal carcinomatosis from colorectal and appendiceal cancer. World J Surg. 1995;19(2):235–40. https://doi.org/10.1007/bf00308632 .
doi: 10.1007/bf00308632
pubmed: 7754629
Kianmanesh R, Scaringi S, Sabate J-M, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases. Ann Surg. 2007;245(4):597–603. https://doi.org/10.1097/01.sla.0000255561.87771.11
doi: 10.1097/01.sla.0000255561.87771.11
pubmed: 17414609
pmcid: 1877034
Esquivel J, Sticca R, Sugarbaker P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol. 2007;14(1):128–33. https://doi.org/10.1245/s10434-006-9185-7
doi: 10.1245/s10434-006-9185-7
pubmed: 17072675
Elias D, Sideris L, Pocard M, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol. 2004;11(3):274–80. https://doi.org/10.1245/aso.2004.03.085
doi: 10.1245/aso.2004.03.085
pubmed: 14993022
Elias D, Ouellet J-F, Bellon N, Pignon J-P, Pocard M, Lasser P. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg. 2003;90(5):567–74. https://doi.org/10.1002/bjs.4071
doi: 10.1002/bjs.4071
pubmed: 12734864
Varban O, Levine EA, Stewart JH, McCoy TP, Shen P. Outcomes associated with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy in colorectal cancer patients with peritoneal surface disease and hepatic metastases. Cancer. 2009;115(15):3427–36. https://doi.org/10.1002/cncr.24385
doi: 10.1002/cncr.24385
pubmed: 19499577
Elias DM. Peritoneal carcinomatosis or liver metastases from colorectal cancer: similar standards for a curative surgery? Ann Surg Oncol. 2004;11(2):122–3. https://doi.org/10.1245/aso.2004.12.929
doi: 10.1245/aso.2004.12.929
pubmed: 14761912
Esquivel J, Elias D, Baratti D, Kusamura S, Deraco M. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol. 2008;98(4):263–7. https://doi.org/10.1002/jso.21053
doi: 10.1002/jso.21053
pubmed: 18726889
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74. https://doi.org/10.1007/978-1-4613-1247-5_23
doi: 10.1007/978-1-4613-1247-5_23
pubmed: 8849962
Pelz JOW, Stojadinovic A, Nissan A, Hohenberger W, Esquivel J. Evaluation of a peritoneal surface disease severity score in patients with colon cancer with peritoneal carcinomatosis. J Surg Oncol. 2009;99(1):9–15. https://doi.org/10.1002/jso.21169
doi: 10.1002/jso.21169
pubmed: 18937291
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/sla.0b013e3181b13ca2
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Reddy SK, Barbas AS, Turley RS, et al. A standard definition of major hepatectomy: resection of four or more liver segments. HPB. 2011;13(7):494–502. https://doi.org/10.1111/j.1477-2574.2011.00330.x
doi: 10.1111/j.1477-2574.2011.00330.x
pubmed: 21689233
pmcid: 3133716
Allard MA, Adam R, Ruiz A, et al. Is unexpected peritoneal carcinomatosis still a contraindication for resection of colorectal liver metastases? Eur J Surg Oncol. 2013;39(9):981–7. https://doi.org/10.1016/j.ejso.2013.06.009
doi: 10.1016/j.ejso.2013.06.009
pubmed: 23845705
Elias D, Liberale G, Vernerey D, et al. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2005;12(11):900–9. https://doi.org/10.1245/aso.2005.01.010
doi: 10.1245/ASO.2005.01.010
pubmed: 16184442
Chua TC, Yan TD, Zhao J, Morris DL. Peritoneal carcinomatosis and liver metastases from colorectal cancer treated with cytoreductive surgery perioperative intraperitoneal chemotherapy and liver resection. Eur J Surg Oncol. 2009;35(12):1299–305. https://doi.org/10.1016/j.ejso.2009.07.005
doi: 10.1016/j.ejso.2009.07.005
pubmed: 19632081
Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28(1):63–8. https://doi.org/10.1200/jco.2009.23.9285
doi: 10.1200/JCO.2009.23.9285
pubmed: 19917863
de Cuba EMV, Kwakman R, Knol DL, Bonjer HJ, Meijer GA, te Velde EA. Cytoreductive surgery and HIPEC for peritoneal metastases combined with curative treatment of colorectal liver metastases. Cancer Treat Rev. 2013;39(4):321–7. https://doi.org/10.1016/j.ctrv.2012.11.003
doi: 10.1016/j.ctrv.2012.11.003
pubmed: 23244778
Delhorme J-B, Dupont-Kazma L, Addeo P, et al. Peritoneal carcinomatosis with synchronous liver metastases from colorectal cancer: Who will benefit from complete cytoreductive surgery? Int J Surg. 2016;25:98–105. https://doi.org/10.1016/j.ijsu.2015.11.025
doi: 10.1016/j.ijsu.2015.11.025
pubmed: 26607853
Alzahrani N, Ung L, Valle SJ, Liauw W, Morris DL. Synchronous liver resection with cytoreductive surgery for the treatment of liver and peritoneal metastases from colon cancer: results from an Australian centre. ANZ J Surg. 2017;87(11):E167–72. https://doi.org/10.1111/ans.13231
doi: 10.1111/ans.13231
pubmed: 26178318
Berger Y, Aycart S, Tabrizian P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with liver involvement. J Surg Oncol. 2016;113(4):432–7. https://doi.org/10.1002/jso.24153
doi: 10.1002/jso.24153
pubmed: 26804119
Glockzin G, Renner P, Popp FC, et al. Hepatobiliary procedures in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2011;18(4):1052–9. https://doi.org/10.1245/s10434-010-1415-3
doi: 10.1245/s10434-010-1415-3
pubmed: 21046262
Gusani NJ, Cho SW, Colovos C, et al. Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center. Ann Surg Oncol. 2008;15(3):754–63. https://doi.org/10.1245/s10434-007-9701-4
doi: 10.1245/s10434-007-9701-4
pubmed: 18080166
Ito K, Takemura N, Inagaki F, et al. Hepatectomy for metachronous colorectal liver metastases following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases: a report of three cases. World J Surg Oncol. 2019;17(1):99. https://doi.org/10.1186/s12957-019-1646-0
doi: 10.1186/s12957-019-1646-0
pubmed: 31196097
pmcid: 6567639