Evaluation of the treatment of peritoneal carcinomatosis of colorectal cancer (CRC) with complete cytoreduction and hyperthe....

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Author(s): D. Hompes, A. D'Hoore, E. Van Cutsem, W. Ceelen, M. Peeters, K. Van der Speeten, C. Bertrand, J. Kerger, H. Legendre; University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
 
Abstract:
Background: Up to 25% of patients with metastatic CRC present with peritoneal carcinomatosis (PC) as the only site of metastases. The concept of Complete Cytoreductive Surgery (CCRS) followed by Hyperthermia and Intraperitoneal Chemotherapy (HIPEC) was developed, aiming for locoregional disease control and long-term survival.
 
Methods: This prospective multicentre registry included 48 patients (M/F ratio 17/31) with PC from CRC, who underwent CCRS and HIPEC with oxaliplatin(460mg/m²). In 72.9% of patients the primary tumor had been previously resected. Median PCI (peritoneal cancer index) was 11 [1-22], with a median of 6 [1-11] abdominal regions involved and a median lesion size score of 3 [1-3]. In 11 cases associated lymph nodes (63.6% mesenteric, 27.3% para-aortic) were resected. To obtain CCRS a median of 2 [2-6] organs needed to be resected, with anterior resection in 45.8%, total colectomy in 8.3% and small bowel resection in 12.5% of cases. A median of 1 [0-6] anastomosis was performed per patient, of which one third were low and 82.1% were performed after HIPEC. Eleven ileostomies and 5 colostomies were constructed.
 
Results: Median operation time was 460min.[125-840], with a median blood loss of 475ml [2- 6000]. HIPEC posed few procedural problems. There was no postoperative mortality. Complication rate was 52.1%, with 18 intra- and 17 extra-abdominal complications. Anastomotic leakage occurred in 10.4% of patients, bleeding in 6.3% and prolonged ileus in 22.9%. Median hospital stay was 20 [5-65] days. Occurrence of intra-abdominal complications significantly affected hospital stay (p=0.0012), but no risk factors for occurrence of postoperative complications could be clearly identified. Median follow-up was 22.7 [3.2-55.7] months, with 91.7% 2-year overall survival. Progression-free survival at 2 years is 64.6%, with PC recurrence in 29.2% of patients and other metastatic disease in 25%. Multivariate analysis only retained the CEA-level as a significant prognostic factor (p=0.0065).
 
Conclusions: CCRS followed by HIPEC for PC of colorectal origin is safe and has longer than expected PFS and OS.