Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer
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Background: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome.
Methods: Patients having surgical debulking and IP 5-fluoro-2′-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively.
Results: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m2 daily for 3 days) and IP leucovorin (240 mg/m2) with a median cycle number of 4 (range, 1–28). The median number of complications was 1 (range, 0–5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0–132 months). The median survival was 34 months (range, 2–132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection.
Conclusions: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.
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- Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer
Annals of Surgical Oncology
Volume 8, Issue 10 , pp 787-795
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Colon cancer
- Appendix cancer
- Intraperitoneal chemotherapy
- Industry Sectors
- Alfred T Culliford IV MD (1)
- Ari D. Brooks MD (1)
- Sunil Sharma MD (2)
- Leonard B. Saltz MD, (2)
- Gary K. Schwartz MD (2)
- Eileen M. O’Reilly MD (2)
- David H. Ilson MD (2)
- Nancy E. Kemeny MD, (2)
- David P. Kelsen MD (2)
- Jose G. Guillem MD (1)
- W Douglas Wong MD, (1)
- Alfred M. Cohen MD (3)
- Philip B. Paty MD (1) (4)
- Author Affiliations
- 1. Colorectal Service, Department of Surgery ATC, ADB, JGG, WDW, PBP, Memorial Sloan-Kettering Cancer Center, New York, New York
- 2. the Division of Medical Oncology, Department of Medicine SS, LBS, GKS, EMO, DHI, NEK, DPK, New York, New York
- 3. the Lucille P. Markey Cancer Center AMC, University of Kentucky, New York, New York
- 4. Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021