Prospective Comparative Analysis of Total Versus Involved Field Parietal Peritonectomy During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) for Peritoneal Surface Malignancies from Colorectal Cancer

Abstract

Peritonectomy is the important component in management of peritoneal surface malignancies (PSM). The aim of this study was to assess the morbidity, recurrence pattern and oncological outcomes of extent of parietal peritonectomy done during CRS and HIPEC for colorectal carcinoma (CRC). Patients with PSM from CRC underwent total parietal peritonectomy (TPP) or IFP with CRS-HIPEC. Pre- and intra-operative data were analysed with main focus on postoperative morbidity, recurrence pattern and oncological outcomes. Of 40 patients in the study, 19 and 21 patients underwent TPP and IFP respectively. TPP group had longer duration of surgery (11 vs 9), more blood loss (1300 vs 835 ml), increased diaphragmatic resections (47.3% vs 9.5%) and multivisceral resection (47.3% vs 28.5%). Overall, G3–G5 morbidity TPP versus IFP was 47.3% versus 33.3% and surgical morbidity was 30.7% versus 23.8%. With a median follow-up of 30 months, DFS was significantly higher in the TPP group (12 months vs 8 months, p < 0.01) and a median overall survival was 21 months in the IFP group (yet to be achieved in the TPP group). The TPP group had most of the recurrences in visceral liver and lung (50.0%) followed by peritoneal (37.5%) and nodal (12.5%), whereas in IFP, it was peritoneum (42.8%), visceral (38.4%) and nodal (15.3%). The TPP group had significantly higher DFS and trend towards improved OS. This indicates aggressive surgical resection has benefit with manageable postoperative morbidity. However, longer follow-up and a prospective multi-institutional randomised study need to be designed for more evidence of the same.