Abstract
BackgroundCombining cytoreductive surgery (CRS) with Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer. The present study evaluates the small bowel subset of the Peritoneal Cancer Index (Small-Bowel-PCI score (SB-PCI), min-max 0–12) as a prognostic factor in such patients.MethodsWe retrospectively analyzed patients that underwent CRS and HIPEC for recurrent colorectal cancer with peritoneal metastasis. Patient characteristics, procedure details, and clinical outcomes were evaluated.ResultsEighty patients were included. The mean intraoperative PCI-score was 16.8, with a mean SB-PCI score of 5.9. CC0/1 was achieved in 62/80 patients. The mean follow-up period was 26.3 months. Univariate regression analysis showed that the ECOG status, the presence of severe complications, the HIPEC regimen (oxaliplatin vs. mitomycin-C), the PCI score, the SB-PCI score and the completeness of cytoreduction correlated significantly with overall survival. In multivariate analysis, the SB-PCI and CC score were identified as independent prognostic factors of survival. When the SB-PCI was stratified in three groups (0–4, 5–8 and 9–12), Kaplan–Meier curve analysis showed significant difference in survival (p<0.001).ConclusionsThe SB-PCI correlates with overall survival in patients with peritoneal metastases secondary to colorectal cancer in this retrospective cohort. Its use should be validated in prospective patient series.
Highlights
Colorectal cancer represents the third most common cancer and the fourth most common cause of cancer-related death worldwide [1]
The SB-peritoneal cancer index (PCI) and CC score were identified as independent prognostic factors of survival
The first randomized trial comparing cytoreduction plus Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) followed by systemic chemotherapy vs. systemic chemotherapy only, showed significant benefit from the combined treatment [7]
Summary
Colorectal cancer represents the third most common cancer and the fourth most common cause of cancer-related death worldwide [1]. Patients with colorectal cancer peritoneal metastasis have been regarded as terminal, with only palliative surgery and/or systemic chemotherapy being recommended [5]. In selected patients, the combination of extensive cytoreductive surgery (CRS) with Hyperthermic intra-operative IntraPeritoneal Chemotherapy (HIPEC) has been reported to confer a benefit in survival of patients with peritoneal metastasis from colorectal cancer [6,7,8]. Combining cytoreductive surgery (CRS) with Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer. Univariate regression analysis showed that the ECOG status, the presence of severe complications, the HIPEC regimen (oxaliplatin vs mitomycin-C), the PCI score, the SB-PCI score and the Keywords: colorectal cancer, cytoreductive surgery, Hyperthermic IntraPeritoneal Chemotherapy (HIPEC), PCI score, small bowel
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