Abstract

BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective routine treatments for colorectal peritoneal metastasis (PM). However, the safety and efficacy of neoadjuvant chemotherapy (NAC) before CRS+HIPEC are poorly understood. Therefore, this study aimed to assess the perioperative safety and long-term efficacy of NAC prior to CRS+HIPEC for patients with synchronous colorectal PM.MethodsPatients with synchronous colorectal PM who received NAC prior to CRS+HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. The clinicopathologic characteristics, perioperative parameters, and survival rates of patients who underwent CRS+HIPEC with NAC (NAC group) and patients who underwent CRS+HIPEC without NAC (non-NAC group) were compared.ResultsThe study enrolled 52 patients, with 20 patients in the NAC group and 32 in the non-NAC group. In the NAC group, the proportion of patients with a peritoneal carcinomatosis index (PCI) score < 12 was significantly higher than that in the non-NAC group (80.0% vs 50.0%, P = 0.031), and more patients achieved complete cytoreduction (80.0% vs 46.9%, P = 0.018). The two groups had comparable grade III/IV complications and similar reoperation and mortality rates (P > 0.05). However, patients who received NAC had lower platelet counts (151.9 vs 197.7 × 109/L, P = 0.036) and neutrophil counts (4.7 vs 7.2 × 109/L, P = 0.030) on postoperative day 1. More patients survived for 2 years in the NAC group than in the non-NAC group (67.4% vs 32.2%, respectively, P = 0.044). However, the completeness of cytoreduction score (HR, 2.99; 95% CI, 1.14–7.84; P = 0.026), rather than NAC, was independently associated with overall survival (OS) in the multivariate analysis after controlling for confounding factors.ConclusionNAC administration before CRS+HIPEC can be regarded as safe and feasible for patients with colorectal PM with comparably low mortality rates and acceptable morbidity rates. Nevertheless, large-sample randomized controlled studies are needed to confirm whether the administration of NAC before CRS+HIPEC confers a survival benefit to patients.

Highlights

  • The peritoneum is the second most common site of colorectal cancer (CRC) metastasis after the liver [1], and 5–15% of CRC patients exhibit evidence of synchronous peritoneal metastasis (PM) [2, 3]

  • Large-sample randomized controlled studies are needed to confirm whether the administration of neoadjuvant chemotherapy (NAC) before Cytoreductive surgery (CRS)+hyperthermic intraperitoneal chemotherapy (HIPEC) confers a survival benefit to patients

  • Relevant studies have demonstrated that NAC before CRS+HIPEC is safe for CRC patients with PM and can provide certain survival benefits [16, 17]

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Summary

Introduction

The peritoneum is the second most common site of colorectal cancer (CRC) metastasis after the liver [1], and 5–15% of CRC patients exhibit evidence of synchronous peritoneal metastasis (PM) [2, 3]. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been carried out at experienced centres for select patients after extensive exploration and has become the cornerstone therapeutic strategy aiming to cure PM of CRC origin [5,6,7]. The median survival can reach approximately 40 months after CRS and HIPEC treatment for PM arising from CRC [8]. Relevant studies have demonstrated that NAC before CRS+HIPEC is safe for CRC patients with PM and can provide certain survival benefits [16, 17]. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective routine treatments for colorectal peritoneal metastasis (PM). This study aimed to assess the perioperative safety and long-term efficacy of NAC prior to CRS+HIPEC for patients with synchronous colorectal PM

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