Prevention of Peritoneal Metastases from Colon Cancer in High-Risk Patients: Preliminary Results of Surgery plus Prophylactic HIPEC

Paolo Sammartino,Maria Sofia Rosati,Fabio Accarpio,Daniele Biacchi,Angelo Di Giorgio,Maurizio Cardi,Tommaso Cornali,Simone Sibio,Pietro Mingazzini

doi:10.1155/2012/141585

Abstract

The study compared the outcome in patients with advanced colonic cancer at high risk of peritoneal metastases (mucinous or signet-ring cell) without peritoneal or systemic spread, treated with standard colectomy or a more aggressive combined surgical approach. The study included patients with colonic cancer with clinical T3/T4, any N, M0, and mucinous or signet ring cell histology. The 25 patients in the experimental group underwent hemicolectomy, omentectomy, bilateral adnexectomy, hepatic round ligament resection, and appendectomy, followed by HIPEC. The control group comprised 50 patients treated with standard surgical resection during the same period in the same hospital by different surgical teams. Outcome data, morbidity, peritoneal recurrence rate, and overall, and disease-free survival, were compared. Peritoneal recurrence developed in 4% of patients in the experimental group and 22% of controls without increasing morbidity (P < 0.05). Actuarial overall survival curves disclosed no significant differences, whereas actuarial disease-free survival curves showed a significant difference between groups (36.8 versus 21.9 months, P < 0.01). A more aggressive preventive surgical approach combined with HIPEC reduces the incidence of peritoneal recurrence in patients with advanced mucinous colonic cancer and also significantly increases disease-free survival compared with a homogeneous control group treated with a standard surgical approach without increasing morbidity.

Highlights

Epidemiological data indicate that peritoneal spread from colorectal cancer is an event that involves 10–15% of patients at the time of primary cancer resection and about 25–50% of patients with recurrent disease, generally leading to death within weeks or months [1,2,3,4,5]
Locoregional lymph node metastases were found in 34% of patients in the experimental group and in 28% of those in the control group
Except for 1 patient in the experimental group who had grade 2 pancreatitis related to hyperthermic intraperitoneal chemotherapy (HIPEC) toxicity morbidity rates were similar in the two groups

Summary

Introduction

Epidemiological data indicate that peritoneal spread from colorectal cancer is an event that involves 10–15% of patients at the time of primary cancer resection and about 25–50% of patients with recurrent disease, generally leading to death within weeks or months [1,2,3,4,5]. Several features of primary tumors of colorectal origin appear to be related to a later development of peritoneal spread: mucinous colorectal cancers or signet ring cell carcinomas tend preferentially to metastasize to the peritoneum or ovaries [6,7,8,9,10]. One randomized and two nonrandomized, have shown that this combined procedure provides a better outcome than 5-fluorouracil-based chemotherapy or more modern chemotherapy regimens [15,16,17]. Despite these encouraging results, even if 5-year survival can reach a value close to 45% at the expense of a mortality rate ranging from 3 to 5% and a morbidity rate around 30%

Methods

Results

Conclusion