Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases: analysis of short- and long-term outcomes.
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Colorectal Neoplasms
/ drug therapy
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Humans
Hyperthermia, Induced
Hyperthermic Intraperitoneal Chemotherapy
Male
Middle Aged
Peritoneal Neoplasms
/ drug therapy
Prognosis
Retrospective Studies
Survival Rate
Colorectal cancer
Cytoreductive surgery
HIPEC
Morbidity
Mortality
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
02
06
2021
accepted:
08
10
2021
pubmed:
19
10
2021
medline:
3
2
2022
entrez:
18
10
2021
Statut:
ppublish
Résumé
Peritoneal metastases carry the worst prognosis among all sites of colorectal cancer (CRC) metastases. In recent years, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for selected patients with limited peritoneal involvement. We report the evolution of CRS and HIPEC for colorectal peritoneal metastases at a tertiary referral center over a 10-year period. Patients with colorectal peritoneal metastases undergoing CRS and HIPEC were included and retrospectively analyzed at a tertiary referral center from January 2006 to December 2015. Main outcomes included evaluation of grade III/IV complications, mortality rate, overall and disease-free survival, and prognostic factors influencing survival on a Cox multivariate analysis. Sixty-seven CRSs were performed on 67 patients during this time for colorectal peritoneal metastases. The median patient age was 57 years with 55.2% being female. The median peritoneal carcinomatosis index (PCI) was 7, with complete cytoreduction achieved in 65 (97%) cases. Grade > 2 complications occurred in 6 cases (8.9%) with no mortality. The median overall survival for the entire cohort was 41 months, with a 3-year overall survival of 43%. In case of complete cytoreduction, median overall and disease-free survival were 57 months and 36 months respectively, with a 3-year disease-free survival of 62%. Complete cytoreduction and nonmucinous histology were key factors independently associated with improved overall survival. CRS and HIPEC for limited peritoneal metastases from CRC are safe and effective, with acceptable morbidity. In selected patients, it offers a highly favorable long-term outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Peritoneal metastases carry the worst prognosis among all sites of colorectal cancer (CRC) metastases. In recent years, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for selected patients with limited peritoneal involvement. We report the evolution of CRS and HIPEC for colorectal peritoneal metastases at a tertiary referral center over a 10-year period.
METHODS
METHODS
Patients with colorectal peritoneal metastases undergoing CRS and HIPEC were included and retrospectively analyzed at a tertiary referral center from January 2006 to December 2015. Main outcomes included evaluation of grade III/IV complications, mortality rate, overall and disease-free survival, and prognostic factors influencing survival on a Cox multivariate analysis.
RESULTS
RESULTS
Sixty-seven CRSs were performed on 67 patients during this time for colorectal peritoneal metastases. The median patient age was 57 years with 55.2% being female. The median peritoneal carcinomatosis index (PCI) was 7, with complete cytoreduction achieved in 65 (97%) cases. Grade > 2 complications occurred in 6 cases (8.9%) with no mortality. The median overall survival for the entire cohort was 41 months, with a 3-year overall survival of 43%. In case of complete cytoreduction, median overall and disease-free survival were 57 months and 36 months respectively, with a 3-year disease-free survival of 62%. Complete cytoreduction and nonmucinous histology were key factors independently associated with improved overall survival.
CONCLUSIONS
CONCLUSIONS
CRS and HIPEC for limited peritoneal metastases from CRC are safe and effective, with acceptable morbidity. In selected patients, it offers a highly favorable long-term outcomes.
Identifiants
pubmed: 34661754
doi: 10.1007/s00423-021-02353-z
pii: 10.1007/s00423-021-02353-z
pmc: PMC8803682
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2797-2805Informations de copyright
© 2021. The Author(s).
Références
Ann Surg. 2009 Jun;249(6):900-7
pubmed: 19474692
Lancet Oncol. 2021 Feb;22(2):256-266
pubmed: 33476595
Clin Nucl Med. 2013 Aug;38(8):623-9
pubmed: 23797225
Br J Surg. 2007 Nov;94(11):1408-14
pubmed: 17631678
Lancet Oncol. 2006 Jan;7(1):69-76
pubmed: 16389186
J Gastrointest Oncol. 2016 Feb;7(1):72-8
pubmed: 26941985
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Eur J Surg Oncol. 2009 Feb;35(2):202-8
pubmed: 18514475
Cancer Treat Res. 1996;82:359-74
pubmed: 8849962
Updates Surg. 2020 Mar;72(1):163-170
pubmed: 31729630
Ann Oncol. 2016 Aug;27(8):1386-422
pubmed: 27380959
Cancer Treat Rev. 2013 Jun;39(4):321-7
pubmed: 23244778
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
J Surg Oncol. 2008 Sep 15;98(4):263-7
pubmed: 18726889
Ann Surg Oncol. 2017 Apr;24(4):898-905
pubmed: 27878480
Eur J Surg Oncol. 2012 Jun;38(6):509-15
pubmed: 22475555
Lancet Oncol. 2016 Dec;17(12):1709-1719
pubmed: 27743922
Int J Surg Oncol. 2011;2011:468698
pubmed: 22312509
J Clin Oncol. 2010 Jan 1;28(1):63-8
pubmed: 19917863
Anticancer Res. 2014 Apr;34(4):2019-22
pubmed: 24692741
Expert Rev Anticancer Ther. 2008 Nov;8(11):1809-18
pubmed: 18983241
Cancer. 2010 Dec 15;116(24):5608-18
pubmed: 20737573
Ann Surg Oncol. 2003 Oct;10(8):863-9
pubmed: 14527903
World J Gastrointest Oncol. 2010 Feb 15;2(2):98-101
pubmed: 21160927
J Clin Oncol. 2004 Aug 15;22(16):3284-92
pubmed: 15310771
Gastroenterol Res Pract. 2012;2012:836425
pubmed: 22778724
Dis Colon Rectum. 2019 Oct;62(10):1195-1203
pubmed: 31490828
Dis Colon Rectum. 2017 Oct;60(10):999-1017
pubmed: 28891842
Cancer. 2006 Mar 1;106(5):1144-53
pubmed: 16456817
J Clin Oncol. 2003 Oct 15;21(20):3737-43
pubmed: 14551293
Cancer. 2000 Jan 15;88(2):358-63
pubmed: 10640968
Int J Colorectal Dis. 2018 Nov;33(11):1559-1567
pubmed: 30132068
Ann Surg. 2012 Feb;255(2):348-56
pubmed: 22202584
J Clin Oncol. 2009 Feb 10;27(5):681-5
pubmed: 19103728
Ann Surg Oncol. 2017 Apr;24(4):914-922
pubmed: 27896512
Oncotarget. 2017 Apr 27;8(33):55657-55683
pubmed: 28903452
ANZ J Surg. 2016 Nov;86(11):937-941
pubmed: 26179296
Int J Colorectal Dis. 2015 Feb;30(2):205-12
pubmed: 25503801
Gastroenterol Rep (Oxf). 2015 Nov;3(4):298-302
pubmed: 26424828
Ann Surg. 1995 Jan;221(1):29-42
pubmed: 7826158
Colorectal Dis. 2017 Mar;19(3):224-236
pubmed: 28008728
Langenbecks Arch Surg. 1999 Dec;384(6):576-87
pubmed: 10654274
Br J Radiol. 2018 Jan;91(1081):20170519
pubmed: 29099613