Abstract
BackgroundCytoreductive peritoneal surgery (CRS) associated with hyperthermic peritoneal chemotherapy (HIPEC) has long been considered the standard treatment for colorectal peritoneal metastases (CPM). However, although efficacy of surgery has been demonstrated, evidence supporting HIPEC’s role is less certain.MethodOverall survival (OS), progression-free survival (PFS) and morbidity were analysed retrospectively for fifty consecutively included patients treated for colorectal CPM with complete CRS and systemic chemotherapy only.ResultsMedian peritoneal cancer index (PCI) was 8 (range 1-24). 23 patients had liver or lung metastases (LLM). 22 patients had synchronous CPM. 27 complications occurred (12 Grade 1/2, 14 Grade 3, 1 Grade 4a, 0 Grade 5). Median follow-up was 62.5 months (95 %CI 45.4-81.3), median survival 32.4 months (21.5-41.7). Three- and 5-year OS were 45.5% (0.31-0.59) and 29.64% (0.17-0.44) respectively. Presence of LLMs associated with peritoneal carcinomatosis was significantly associated with poorer prognosis, with survival at 5 years of 13.95% (95 %CI 2.9-33.6) vs. 43.87% (22.2-63.7) when no metastases were present (P= 0.018). Median PFS was 9.5 months (95 %CI 6.2-11.1).ConclusionWith an equivalent PCI range and despite one of the highest rates of LLM in the literature, our survival data of CRS + systemic chemotherapy only compare well with results reported after additional HIPEC. Tolerance was better with acceptable morbidity without any mortality. Extra-hepatic metastasis (LLM) is a strong factor of poor prognosis. Awaiting the results of the randomized PRODIGE trial, these results indicate that CRS + systemic chemotherapy only is a robust hypothesis to treat colorectal CPM.
Highlights
With an occurrence rate of 10 to 13%,[1] peritoneal metastases (CPM) is the third most common colorectal metastatic disease after liver and lung metastases
Presence of liver or lung metastases (LLM) associated with peritoneal carcinomatosis was significantly associated with poorer prognosis, with survival at 5 years of 13.95% (95 %CI 2.9-33.6) vs. 43.87% (22.2-63.7) when no metastases were present (P= 0.018)
With an equivalent PCI range and despite one of the highest rates of LLM in the literature, our survival data of cytoreductive surgery (CRS) + systemic chemotherapy only compare well with results reported after additional hyperthermic intraperitoneal chemotherapy (HIPEC)
Summary
With an occurrence rate of 10 to 13%,[1] peritoneal metastases (CPM) is the third most common colorectal metastatic disease after liver and lung metastases. Since the 1990’s, an aggressive curative approach has been proposed for selected patients This treatment includes cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).[3,4] By misnomer, HIPEC is often used in the literature to refer to the combination of surgical and properly said, HIPEC treatments (referred to as CRS + HIPEC in this paper). This combined surgery and HIPEC treatment is performed in highly specialized and tertiary care centres in which CRS +HIPEC has become the standard treatment for CPM.[5]. Efficacy of surgery has been demonstrated, evidence supporting HIPEC’s role is less certain
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