Abstract
Background and Aims. Intraperitoneal chemotherapy is a basic tool in the treatment of peritoneal malignancy. The purpose of the study is to investigate the effect of adjuvant perioperative intraperitoneal chemotherapy in the treatment of locally advanced colorectal cancer. Patients and Methods. Patients with T3 and T4 colorectal carcinomas that underwent R0 resection received either hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC group = 40 patients) or early postoperative intraperitoneal chemotherapy (EPIC group = 67 patients). The survival, the recurrences and the sites of recurrence were assessed. Results. The 3-year survival rate for HIPEC group was 100% and for EPIC group 69% (P = .011). Nodal infiltration was found to be the single prognostic indicator of survival. The incidence of recurrence in EPIC group was higher than in HIPEC group (P = .009). The independent indicators of recurrence were the use of HIPEC and the degree of differentiation (P < .05). Conclusions. Intraperitoneal chemotherapy, particularly HIPEC, as an adjuvant in locally advanced colorectal carcinomas appears to improve survival and decrease the incidence of recurrence.
Highlights
The incidence of recurrence for Dukes’ B and C colorectal carcinomas is approximately 50% [1]
If chemotherapy is used by the intraperitoneal route, microscopic residual tumor resulting from surgical manipulations in locally advanced colorectal cancer surgery may possibly be eradicated
Five patients from the Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC)-group and 6 patients from the early postoperative intraperitoneal chemotherapy (EPIC) group were rejected from the analysis because they were found to have pT2N0M0 tumors or they had peritoneal malignancy
Summary
The incidence of recurrence for Dukes’ B and C colorectal carcinomas is approximately 50% [1]. The incidence of locoregional recurrence has been reduced significantly by total mesorectal excision [3] Similar to this approach, extensive lymph node resection has been questioned for colon cancer [4]. Preoperative irradiation in rectal cancer has been shown to significantly reduce the incidence of locoregional recurrences [6], but only one study showed improvement of survival [7]. If chemotherapy is used by the intraperitoneal route, microscopic residual tumor resulting from surgical manipulations in locally advanced colorectal cancer surgery may possibly be eradicated. The purpose of the study is to investigate the effect of adjuvant perioperative intraperitoneal chemotherapy in the treatment of locally advanced colorectal cancer. Intraperitoneal chemotherapy, HIPEC, as an adjuvant in locally advanced colorectal carcinomas appears to improve survival and decrease the incidence of recurrence
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