Abstract
ObjectivesThe therapeutic efficacy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is still under debate. This meta-analysis and systematic review of published literature on this comprehensive strategy aims to evaluate its efficacy on CRC patients with PC.MethodsA systemic review with meta-analysis of published literatures on treatment of CRS plus HIPEC for patients with PC from CRC was performed. In addition, a summary of study results of published literatures concerning CRS plus HIPEC treating patients with PC from CRC was also conducted.ResultsA total of 76 studies were selected, including 1 randomized controlled trial, 14 non-randomized controlled studies, and 61 non-controlled studies. The pooled hazard ratios (HRs) for overall survival (OS) in the 15 researches for meta-analysis was 2.67 (95% CI, 2.21-3.23, I2= 0%, P < 0.00001), and no significant evidence of publication bias was found. The difference of chemotherapy regimens of HIPEC was not associated with OS and DFS (disease-free survival) after CRS and HIPEC, with no significant difference of heterogeneity (P = 0.27, I2 = 24.1%). In both groups of mitomycin C based HIPEC group and oxaliplatin group, patients received HIPEC had significant better survival (P < 0.00001). The mean mortality and morbidity for HIPEC program were 2.8% and 33.0%, respectively.ConclusionsThis meta-analysis revealed that comprehensive therapeutic strategy of CRS plus HIPEC could bring survival benefit for selected patients with PC from CRC with acceptable safety.
Highlights
Peritoneal carcinomatosis (PC), as a lethal regional progression for patients with colorectal cancer (CRC), has long been considered as a terminal condition with few effective treatments
This meta-analysis revealed that comprehensive therapeutic strategy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) could bring survival benefit for selected patients with PC from CRC with acceptable safety
Researches on treatment of CRC PC did not reveal promising progress until the development of a comprehensive treatment strategy including cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and perioperative chemotherapy. [8,9,10,11,12,13,14,15] This new comprehensive treatment improves the median overall survival (OS) of selected patients with CRC PC up to 2163 months, and 5-year survival rate up to approximately 40% [16,17,18,19,20,21,22,23,24,25,26,27,28], or even 58% according to the American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution study [29]
Summary
Peritoneal carcinomatosis (PC), as a lethal regional progression for patients with colorectal cancer (CRC), has long been considered as a terminal condition with few effective treatments. [8,9,10,11,12,13,14,15] This new comprehensive treatment improves the median OS of selected patients with CRC PC up to 2163 months, and 5-year survival rate up to approximately 40% [16,17,18,19,20,21,22,23,24,25,26,27,28], or even 58% according to the American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution study [29]. In the 9th International Congress on Peritoneal Surface Malignancies in Amsterdam in 2014, peritoneal surface oncology group international (PSOGI) reached a consensus that CRS+HIPEC should be considered as the standard therapy for the selected patients with mild-tomoderate CRC PC [33]
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