Peritoneal surface disease with synchronous hepatic involvement treated with Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Abstract

Patients with peritoneal surface disease (PSD) often present with synchronous hepatic involvement (HI). The impact of addressing the hepatic component during CRS/HIPEC on operative and survival outcomes is not clearly defined. A prospective database of 1,067 procedures was reviewed based on primary tumor, performance status, resection status, type of liver involvement (superficial or parenchymal) and hepatic resection, morbidity, mortality, and overall survival. There were 108 (10%) CRS/HIPEC procedures performed with synchronous liver debulking in 99 patients with PSD from 27 (33%) appendiceal and 32 (39%) colorectal primary lesions. Ninety percent of patients underwent subsegmental hepatic resection, whereas 22% had disease with hepatic parenchymal involvement. Median intensive care unit (ICU) and hospital stay were 3.5 and 13.6days, respectively. Clavien grade III/IV morbidity was similar for patients with or without resected HI (18.9 vs. 22.5%; p=0.39). The 30-day mortality rate was 6.5 and 2.8% (p=0.07) for patients with and without resected HI, respectively. The median survival for all patients with low-grade appendiceal cancer was 42.1months with resected HI and 95.5months without HI (p=0.03). Median survival for colorectal cancer patients after complete cytoreduction was 21.2months with HI versus 33.6months without HI (p=0.03). Synchronous resection of limited HI does not increase the morbidity or mortality of CRS/HIPEC procedures. The survival benefit, although still meaningful, was less for patients with HI. Resectable low volume HI in patients with PSD from colon and appendiceal primary lesions should not be considered a contraindication for CRS/HIPEC procedures.