Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy: A Feasible and Effective Option for Colorectal Cancer Patients After Emergency Surgery in the Presence of Peritoneal Carcinomatosis

Abstract

When peritoneal carcinomatosis (PC) is diagnosed during emergency surgery for colorectal cancer (CRC), further treatment with curative intent may seem futile given the known poor prognosis of both PC and emergency surgery. The aim of the current study was to investigate the feasibility and effectiveness of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRC patients who previously underwent emergency surgery in the presence of PC. All patients with synchronous PC of CRC referred to two tertiary centers between April 2005 and November 2013 were included in this study. Operative, postoperative and survival details were compared between patients presenting in an emergency or elective setting. In total, 149 patients with synchronous PC underwent CRS and HIPEC. Amongst these patients, 36 (24.2%) initially presented with acute symptoms requiring emergency surgery. Acute presentation did not result in a longer interval between the initial operation and HIPEC (2.2 vs. 2.1months; P=0.09). When comparing operative outcomes, no significant differences were found in blood loss (P=0.47), operation time (P=0.39), or completeness of cytoreduction (P=0.97). In addition, complication rates, degree and types of complication did not differ between the groups. Median survival was 36.1months for emergency presentation compared with 32.1 in the elective group (P=0.73). CRS+HIPEC may be performed safely in patients with PC of colorectal origin presenting with acute symptoms requiring emergency surgery. More importantly, the 5-year survival rate in these patients was equal to elective cases. This should be regarded as promising and therefore considered for these patients.