Colorectal peritoneal carcinomatosis treated by completed surgery and systemic chemotherapy without HIPEC.

Abstract

e14017 Background: Cytoreductive peritoneal surgery (CPS) associated with hyperthermic peritoneal chemotherapy (HIPEC) has become the standard treatment for peritoneal carcinomatosis (PC) of colorectal origins. Nevertheless, if CPS efficacy is demonstrated, evidence supporting HIPEC role is lacking. Methods: Overall survival (OS), progression-free survival (PFS) and outcomes were analysed retrospectively for thirty consecutively included patients treated for colorectal PC with CPS and systemic chemotherapy only. Outcomes and morbidity of the treatment were compared to outcomes and morbidity in the literature following CPS + HIPEC treatments. Results: PCI indices ranged from 1-21 with a mean of 9. Median hospitalization duration was 15 days (range 5-51), and median intensive care unit stay was 1 day (range 0-7). There was no post-operative mortality. Seventeen complications were Grade 1 or 2 (Dindo & Clavien), and remaining 13 were Grade 3. Median follow up was 40.7 [95%CI: 15.1 – 66.3] months. Median OS was 30.7 months [95%CI: 12.65-48.66}]. OS estimates were 83% [95CI%: 63.9- 92.5] and 45% [95%CI: 23.7-64.4] at 1 year and 3 years respectively. Median PFS was 11.1 months [95%CI: 7.98-14.25]. PFS at one year was 43.2% [95%CI: 24.7-60.4]. Patients without any other metastases (n=17) had a median OS of 73.3 months [95%CI: 25.7-120.9], compared with median OS of 18.7 months [95%CI, 16.9-20.6] for patients with at least one liver or lung metastases (p=0.011). Conclusions: The results obtained for patients with colorectal PC treated by CPS and systemic chemotherapy compare favourably with series including HIPEC in the treatment. No mortality, shorter operation duration and hospitalization, less blood loss and transfusions, and no hematologic toxicity were observed.