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]

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Summary

Introduction

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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