Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Carcinomatosis from Rectal Cancer

Abstract

Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is the treatment most likely to achieve prolonged survival in peritoneal carcinomatosis (PC). Yet the efficacy of HIPEC in rectal patients is controversial because of the retroperitoneal location of the primary tumor. Therefore, we reviewed our experience in patients with PC from a rectal primary tumor. A retrospective analysis of a prospective database of 950 HIPEC procedures was performed. Performance status, age, albumin level, prior surgical score, resection status, morbidity, mortality, and survival were reviewed. A total of 13 and 204 patients with PC from rectal and colon cancer, respectively, were identified. Median follow-up was 40.1 and 88.1months, respectively. Eastern Cooperative Oncology Group (ECOG) score was zero or one for 92% of patients with rectal cancer and 83% for colon, while R1 resection was achieved in 54 and 51%. The 30-day mortality was 5% for colon cancer. There were no deaths in the rectal group. The morbidity for the colon and rectal groups was 57 and 46%, respectively, with a 23% 30-day readmission rate. In univariate analysis, age, ECOG, prior surgical score, albumin level, and node and resection status were not statistically significant in predicting survival for the rectal cancer patients. Median survival for the rectal and colon groups was 14.6 versus 17.3months, while the 3-year survival was 28.2 versus 25.1%. Our data demonstrate similar 3-year survival for patients with rectal and colon cancer PC treated with CS/HIPEC. This can be attributed to patient selection bias. Selected rectal cancer PC patients should not be excluded from an attempted cytoreduction and HIPEC.