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Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases : A multi-institutional experience

Alzahrani, Nayef A ; Valle, Sarah J ; Fisher, Oliver M ; Sugarbaker, Paul H ; Yonemura, Yutaka ; Glehen, Olivier ; Goere, Dianne ; Honore, Charles ; Brigand, Cecile and de Hingh, Ignace , et al. (2019) In Journal of Surgical Oncology 119(3). p.336-346
Abstract

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... (More)

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.

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author collaboration
publishing date
type
Contribution to journal
publication status
published
keywords
Adolescent, Adult, Aged, Chemotherapy, Cancer, Regional Perfusion/mortality, Colorectal Neoplasms/mortality, Combined Modality Therapy, Cytoreduction Surgical Procedures/mortality, Female, Follow-Up Studies, Humans, Hyperthermia, Induced/mortality, Male, Middle Aged, Neoplasm Recurrence, Local/mortality, Peritoneal Neoplasms/mortality, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Young Adult
in
Journal of Surgical Oncology
volume
119
issue
3
pages
336 - 346
publisher
Wiley-Blackwell
external identifiers
  • scopus:85058572933
  • pmid:30554404
ISSN
0022-4790
DOI
10.1002/jso.25277
language
English
LU publication?
no
additional info
© 2018 Wiley Periodicals, Inc.
id
efe8e2ba-6f7e-4c86-bb68-091c35e782f2
date added to LUP
2022-04-04 17:12:19
date last changed
2025-01-15 16:28:50
@article{efe8e2ba-6f7e-4c86-bb68-091c35e782f2,
  abstract     = {{<p>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.</p><p>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.</p><p>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) &gt; 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI &gt; 10 ( P = 0.03 for PCI 11-20; P &lt; 0.001 for PCI &gt; 20), high-grade complications ( P = 0.012), and incomplete cytoreduction ( P &lt; 0.001).</p><p>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.</p>}},
  author       = {{Alzahrani, Nayef A and Valle, Sarah J and Fisher, Oliver M and Sugarbaker, Paul H and Yonemura, Yutaka and Glehen, Olivier and Goere, Dianne and Honore, Charles and Brigand, Cecile and de Hingh, Ignace and Verwaal, Vic J and Deraco, Marcello and Baratti, Dario and Kusamura, Shigeki and Pocard, Mark and Piso, Pompiliu and Maerz, Loreen and Marchal, Frederic and Moran, Brendan and Levine, Edward A and Dumont, Frédéric and Pezet, Denis and Abboud, Karine and Kozman, Mathew A and Liauw, Winston and Morris, David L}},
  issn         = {{0022-4790}},
  keywords     = {{Adolescent; Adult; Aged; Chemotherapy, Cancer, Regional Perfusion/mortality; Colorectal Neoplasms/mortality; Combined Modality Therapy; Cytoreduction Surgical Procedures/mortality; Female; Follow-Up Studies; Humans; Hyperthermia, Induced/mortality; Male; Middle Aged; Neoplasm Recurrence, Local/mortality; Peritoneal Neoplasms/mortality; Prognosis; Prospective Studies; Retrospective Studies; Survival Rate; Young Adult}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{336--346}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Surgical Oncology}},
  title        = {{Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases : A multi-institutional experience}},
  url          = {{http://dx.doi.org/10.1002/jso.25277}},
  doi          = {{10.1002/jso.25277}},
  volume       = {{119}},
  year         = {{2019}},
}