Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases.
Cytoreductive surgery
HIPEC
Pelvic peritonectomy
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
30
04
2022
accepted:
22
10
2022
pubmed:
4
11
2022
medline:
28
1
2023
entrez:
3
11
2022
Statut:
ppublish
Résumé
Constraints of pelvic anatomy render complete cytoreduction (CRS) challenging. The aim of this study is to investigate the impact of pelvic peritonectomy during CRS/HIPEC on colorectal peritoneal metastasis (CRPM) patients' outcomes. This is a retrospective analysis of a prospectively maintained CRS/hyperthermic intraperitoneal chemotherapy (HIPEC) database. The analysis included 217 patients with CRPM who had a CRS/HIPEC between 2014 and 2021. We compared perioperative and oncological outcomes of patients with pelvic peritonectomy (PP) (n = 63) to no pelvic peritonectomy (non-PP) (n = 154). No differences in demographics were identified. The peritoneal cancer index (PCI) was higher in the PP group with a median PCI of 12 vs. 6 in the non-PP group (p < 0.001). Operative time was 4.9 vs. 4.3 h in the PP and non-PP groups, respectively (p = 0.63). Median hospitalization was longer in the PP group at 12 vs. 10 days (p = 0.007), and the rate of complications were higher in the PP group at 57.1% vs. 39.6% (p = 0.018). Pelvic peritonectomy was associated with worse disease-free (DFS) and overall survival (OS) with 3-year DFS and OS of 7.3 and 46.3% in the PP group vs. 28.2 and 87.8% in the non-PP group (p = 0.028, p .> 0.001). The univariate OS analysis identified higher PCI (p = 0.05), longer surgery duration (p = 0.02), and pelvic peritonectomy (p < 0.001) with worse OS. Pelvic peritonectomy remained an independent prognostic variable, irrespective of PCI, on the multivariate analysis (p < 0.001). Pelvic peritonectomy at the time of CRS/HIPEC is associated with higher morbidity and worse oncological outcomes. These findings should be taken into consideration in the management of patients with pelvic involvement.
Sections du résumé
BACKGROUND
Constraints of pelvic anatomy render complete cytoreduction (CRS) challenging. The aim of this study is to investigate the impact of pelvic peritonectomy during CRS/HIPEC on colorectal peritoneal metastasis (CRPM) patients' outcomes.
METHODS
This is a retrospective analysis of a prospectively maintained CRS/hyperthermic intraperitoneal chemotherapy (HIPEC) database. The analysis included 217 patients with CRPM who had a CRS/HIPEC between 2014 and 2021. We compared perioperative and oncological outcomes of patients with pelvic peritonectomy (PP) (n = 63) to no pelvic peritonectomy (non-PP) (n = 154).
RESULTS
No differences in demographics were identified. The peritoneal cancer index (PCI) was higher in the PP group with a median PCI of 12 vs. 6 in the non-PP group (p < 0.001). Operative time was 4.9 vs. 4.3 h in the PP and non-PP groups, respectively (p = 0.63). Median hospitalization was longer in the PP group at 12 vs. 10 days (p = 0.007), and the rate of complications were higher in the PP group at 57.1% vs. 39.6% (p = 0.018). Pelvic peritonectomy was associated with worse disease-free (DFS) and overall survival (OS) with 3-year DFS and OS of 7.3 and 46.3% in the PP group vs. 28.2 and 87.8% in the non-PP group (p = 0.028, p .> 0.001). The univariate OS analysis identified higher PCI (p = 0.05), longer surgery duration (p = 0.02), and pelvic peritonectomy (p < 0.001) with worse OS. Pelvic peritonectomy remained an independent prognostic variable, irrespective of PCI, on the multivariate analysis (p < 0.001).
CONCLUSIONS
Pelvic peritonectomy at the time of CRS/HIPEC is associated with higher morbidity and worse oncological outcomes. These findings should be taken into consideration in the management of patients with pelvic involvement.
Identifiants
pubmed: 36327025
doi: 10.1007/s11605-022-05501-y
pii: 10.1007/s11605-022-05501-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
131-140Informations de copyright
© 2022. The Society for Surgery of the Alimentary Tract.
Références
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
Holch JW, Demmer M, Lamersdorf C, et al. Pattern and Dynamics of Distant Metastases in Metastatic Colorectal Cancer. Visc Med. 2017;33(1):70-75. https://doi.org/10.1159/000454687
doi: 10.1159/000454687
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):1041-1049. https://doi.org/10.1097/DCR.0000000000000858
doi: 10.1097/DCR.0000000000000858
Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89(12):1545-1550. https://doi.org/10.1046/j.1365-2168.2002.02274.x
doi: 10.1046/j.1365-2168.2002.02274.x
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):5721-5727. https://doi.org/10.1200/JCO.2008.17.7147
doi: 10.1200/JCO.2008.17.7147
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
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):787-795. https://doi.org/10.1001/jamaoncol.2015.1790
doi: 10.1001/jamaoncol.2015.1790
Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 14(3):254–261. https://doi.org/10.1002/(sici)1098-2388(199804/05)14:3<254::aid-ssu10>3.0.co;2-u
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):3284-3292. https://doi.org/10.1200/JCO.2004.10.012
doi: 10.1200/JCO.2004.10.012
Verwaal VJ, van Ruth S, de Bree EE, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. Journal of Clinical Oncology. 2003;21(20):3737-3743. https://doi.org/10.1200/JCO.2003.04.187
doi: 10.1200/JCO.2003.04.187
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):2426-2432. https://doi.org/10.1245/s10434-008-9966-2
doi: 10.1245/s10434-008-9966-2
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):681-685. https://doi.org/10.1200/JCO.2008.19.7160
doi: 10.1200/JCO.2008.19.7160
Newton AD, Bartlett EK, Karakousis GC. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a review of factors contributing to morbidity and mortality. J Gastrointest Oncol. 2016;7(1):99-111. https://doi.org/10.3978/j.issn.2078-6891.2015.100
doi: 10.3978/j.issn.2078-6891.2015.100
Di Miceli D, Alfieri S, Caprino P, et al. Complications related to hyperthermia during hypertermic intraoperative intraperitoneal chemiotherapy (HIPEC) treatment. Do they exist? Eur Rev Med Pharmacol Sci. Published online 2012.
Mor E, Assaf D, Laks S, et al. The impact of gastrointestinal anastomotic leaks on survival of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. The American Journal of Surgery. Published online April 2021. https://doi.org/10.1016/j.amjsurg.2021.03.061
Chouliaras K, Levine EA, Fino N, Shen P, Votanopoulos KI. Prognostic Factors and Significance of Gastrointestinal Leak After Cytoreductive Surgery (CRS) with Heated Intraperitoneal Chemotherapy (HIPEC). Ann Surg Oncol. 2017;24(4):890-897. https://doi.org/10.1245/s10434-016-5738-6
doi: 10.1245/s10434-016-5738-6
Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29-42.
doi: 10.1097/00000658-199501000-00004
SATO T, YAMAGUCHI S, HARADA M, KOYAMA I, BRENNAN MF. Pelvic Peritonectomy without Intraperitoneal Chemotherapy for Localized Peritoneal Carcinomatosis. Anticancer Res. 2013;33(3):975 LP - 980.
Tejerizo-Garcia A, Olloqui A, Lopez G, Alvarez-Conejo C, Caso-Maestro O, Diez A. Step-by-step total pelviperitonectomy with modified posterior pelvic exenteration. International Journal of Gynecologic Cancer. 2020;30(4):558 LP - 558. https://doi.org/10.1136/ijgc-2019-000984
Rady HA. Anterior Pelvic Peritonectomy with Empty or Bladder Distension Technique. Indian J Gynecol Oncol. 2017;15(1):16. https://doi.org/10.1007/s40944-017-0106-4
doi: 10.1007/s40944-017-0106-4
Sugarbaker PH. Avoiding Diverting Ileostomy in Patients Requiring Complete Pelvic Peritonectomy. Ann Surg Oncol. 2016;23(5):1481-1485. https://doi.org/10.1245/s10434-015-4961-x
doi: 10.1245/s10434-015-4961-x
Chang SC, Seow-En I, Ke TW, et al. Laparoscopic total pelvic peritonectomy for colorectal cancer pelvic carcinomatosis: a retrospective case series and photographic/videographic step-by-step guide. Surg Endosc. Published online 2021. https://doi.org/10.1007/s00464-021-08719-0
doi: 10.1007/s00464-021-08719-0
Flood MP, Waters PS, Soucisse M, et al. Pelvic exenteration, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy: experience and outcomes from an exenterative and peritonectomy unit. Langenbecks Arch Surg. Published online 2021. https://doi.org/10.1007/s00423-021-02323-5
doi: 10.1007/s00423-021-02323-5
Di Giorgio A. Peritonectomy Techniques. In: ; 2015:129–154. https://doi.org/10.1007/978-88-470-5711-1_9
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359-374. https://doi.org/10.1007/978-1-4613-1247-5_23
doi: 10.1007/978-1-4613-1247-5_23
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo Classification of Surgical Complications. Ann Surg. 2009;250(2):187-196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
doi: 10.1097/SLA.0b013e3181b13ca2
Xiang L, Ye S, Yang H. Total pelvic peritonectomy for ovarian cancer with extensive peritoneal carcinomatosis in pelvic cavity. Gynecol Oncol. 2019;154(3):651-652. https://doi.org/10.1016/j.ygyno.2019.07.003
doi: 10.1016/j.ygyno.2019.07.003
Clayton RD, Obermair A, Hammond IG, Leung YC, McCartney AJ. The Western Australian experience of the use of en bloc resection of ovarian cancer with concomitant rectosigmoid colectomy. Gynecol Oncol. 2002;84(1):53-57. https://doi.org/10.1006/gyno.2001.6469
doi: 10.1006/gyno.2001.6469
Stamou KM, Karakozis S, Sugarbaker PH. Total abdominal colectomy, pelvic peritonectomy, and end-ileostomy for the surgical palliation of mucinous peritoneal carcinomatosis from non-gynecologic cancer. J Surg Oncol. 2003;83(4):197-203. https://doi.org/10.1002/jso.10270
doi: 10.1002/jso.10270
Chen TC, Liang JT. Robotic low anterior resection with total hysterectomy, bilateral salpingo-oophorectomy and en bloc pelvic peritonectomy followed by hyperthermic intraperitoneal chemotherapy for the multi-modal treatment of rectosigmoid cancer with peritoneal seeding - A. Colorectal Dis. 2021;23(6):1591-1592. https://doi.org/10.1111/codi.15617
doi: 10.1111/codi.15617
Sinukumar S, Rajan F, Mehta S, et al. A comparison of outcomes following total and selective peritonectomy performed at the time of interval cytoreductive surgery for advanced serous epithelial ovarian, fallopian tube and primary peritoneal cancer - A study by INDEPSO. Eur J Surg Oncol. 2021;47(1):75-81. https://doi.org/10.1016/j.ejso.2019.02.031
doi: 10.1016/j.ejso.2019.02.031
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):63-68. https://doi.org/10.1200/JCO.2009.23.9285
doi: 10.1200/JCO.2009.23.9285
Sugarbaker PH, Ryan DP. Cytoreductive surgery plus hyperthermic perioperative chemotherapy to treat peritoneal metastases from colorectal cancer: standard of care or an experimental approach? Lancet Oncol. 2012;13(8):e362-9. https://doi.org/10.1016/S1470-2045(12)70210-3
doi: 10.1016/S1470-2045(12)70210-3
da Silva RG, Sugarbaker PH. Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. J Am Coll Surg. 2006;203(6):878-886. https://doi.org/10.1016/j.jamcollsurg.2006.08.024
doi: 10.1016/j.jamcollsurg.2006.08.024
Cashin PH, Graf W, Nygren P, Mahteme H. Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: Prognosis and treatment of recurrences in a cohort study. European Journal of Surgical Oncology (EJSO). 2012;38(6):509-515. https://doi.org/10.1016/j.ejso.2012.03.001
doi: 10.1016/j.ejso.2012.03.001
Faron M, Macovei R, Goéré D, Honoré C, Benhaim L, Elias D. Linear Relationship of Peritoneal Cancer Index and Survival in Patients with Peritoneal Metastases from Colorectal Cancer. Ann Surg Oncol. 2016;23(1):114-119. https://doi.org/10.1245/s10434-015-4627-8
doi: 10.1245/s10434-015-4627-8
Assaf D, Mor E, Laks S, et al. The pattern of peritoneal colorectal metastasis predicts survival after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. European Journal of Surgical Oncology. Published online August 2021. https://doi.org/10.1016/j.ejso.2021.08.023
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):1709-1719. https://doi.org/10.1016/S1470-2045(16)30500-9
doi: 10.1016/S1470-2045(16)30500-9
Franko J. Therapeutic efficacy of systemic therapy for colorectal peritoneal carcinomatosis: Surgeon’s perspective. Pleura Peritoneum. 2018;3(1). https://doi.org/10.1515/PP-2018-0102
Kranenburg O, Speeten K van der, Hingh I de. Peritoneal Metastases From Colorectal Cancer: Defining and Addressing the Challenges. Front Oncol. 2021;11:650098. https://doi.org/10.3389/FONC.2021.650098
doi: 10.3389/FONC.2021.650098