A Systematic Review and Meta-Analysis of Cytoreductive Surgery with Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin
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The objective of the present meta-analysis was to analyze the survival outcomes of patients with colorectal peritoneal carcinomatosis (CRPC), with particular focus on cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC).
A search was conducted on Medline from 1950 to February 2009 and Pubmed from 1950 to February 2009 for original studies on CRS with PIC. All articles included in this study were assessed with the application of predetermined selection criteria. Results regarding the overall survival in the meta-analysis were expressed as hazard ratios with 95% confidence intervals.
Forty-seven manuscripts were selected in the present systematic review, including 4 comparative studies and 43 observational studies of CRS with PIC. From the meta-analysis, it can be seen that a significant improvement in survival was associated with treatment by CRS and hyperthermic intraperitoneal chemotherapy compared with palliative approach (P < 0.0001). The pooled data did not show a significant improvement in overall survival for patients treated by CRS and early postoperative intraperitoneal chemotherapy versus surgery and systemic chemotherapy (P = 0.35). The overall effect of PIC is significantly better than the control group (P = 0.0002). The current literature suggests that patients with liver metastasis amendable to resection should not be excluded from CRS and PIC. However, there is a need for further evaluation of the prognostic significance of lymph node and liver involvement, ideally in large prospective trials.
The meta-analysis showed that combined therapy involving CRS and PIC had a statistically significant survival benefit over control groups.
- Jayne DG, Fook S, Loi, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer Br J Surg. 2002;89:1545–50. CrossRef
- Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors Cancer. 1989;63:364–7. CrossRef
- Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study Cancer. 2000;88:358–63. CrossRef
- de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer J Clin Oncol. 2000;18:2938–47.
- Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal origin J Clin Oncol. 2003;21:3737–43. CrossRef
- Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials Ann Surg Oncol. 2004;11:518–21. CrossRef
- Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin J Clin Oncol. 2009;27(5):681–5. CrossRef
- Mahteme H, Hansson J, Berglund A, et al. Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study Br J Cancer. 2004;90:403–7. CrossRef
- Elias D. French multi-institutional registry for colorectal peritoneal carcinomatosis. 5th peritonectomy workshop. Lyon, France. Oct 2008. Abstract.
- Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study J Clin Oncol. 2004;22:3284–92. CrossRef
- Gomez Portilla A. Barrios P, Rufian S, et al. Management of peritoneal surface malignancy with cytoreductive surgery and perioperative intraperitoneal chemotherapy Eur J Surg Oncol. 2006;32(6):628–31. CrossRef
- Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy Ann Surg. 1995;221:124–32.
- Sugarbaker PH, Schellinx MET, Chang D, Koslowe P, von Meyerfeldt M. Peritoneal carcinomatosis from adenocarcinoma of the colon World J Surg. 1996;20:585–92. CrossRef
- Pestieau SR, Sugarbaker PH. Treatment of primary colon cancer with peritoneal carcinomatosis: comparison of concomitant vs.. delayed management Dis Colon Rectum. 2000;43:1341–8. CrossRef
- Carmignani CP, Ortega-Perez G, Sugarbaker PH. The management of synchronous peritoneal carcinomatosis and hematogenous metastasis from colorectal cancer Eur J Surg Oncol. 2004;30:391–8. CrossRef
- Gomes da Silva RG, Sugarbaker PH. Analysis of 10 prognostic factors in 70 patients having complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer J Am Coll Surg. 2006; 203(6):878–86. CrossRef
- Beaujard AC, Glehen O, Caillot JL, et al. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis Cancer. 2000;88:2512–19. CrossRef
- Glehen O, Cotte E, Schreiber V, Sayag-Beaujard AC, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin Br J Surg. 2004;91:747–54. CrossRef
- Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy Cancer. 2001;92:71–6. CrossRef
- Elias D, Pocard M, Sideris L, Ede C, Ducreux M, Boige V, Lasser P. Preliminary results of intraperitoneal chemohyperthermia with oxaliplatin in peritoneal carcinomatosis of colorectal origin Br J Surg. 2004;91:455–6. CrossRef
- Elias D, Raynard B, Farkhondeh F, et al. Peritoneal carcinomatosis of colorectal origin: long-term results of intraperitoneal chemohyperthermia with oxaliplatin following complete cytoreductive surgery Gastroenterol Clin Biol. 2006;30(10):1200–4.
- Elias D, Benizri E, DiPietrantonio D, Menegon P, Malka D, Raynard B. Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis Ann Surg Oncol. 2007;14(2):509–14. CrossRef
- Elias D, Goere D, Blot F, Billard V, Pocard M, Kohneh-Shahri N, et al. Optimization of hyperthermic intraperitoneal chemotherapy with oxaliplatin plus irinotecan at 43 degrees C after compete cytoreductive surgery: mortality and morbidity in 106 consecutive patients Ann Surg Oncol. 2007;14(6):1818–24. CrossRef
- Witkamp AJ, de Bree E, Kaag MM, et al. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin C in patients with peritoneal carcinomatosis of colorectal origin Eur J Cancer. 2001;37:979–84. CrossRef
- Verwaal VJ, van Tinteren H, van Ruth S, Zoetmulder FA. Predicting the survival of patients with peritoneal carcinomatosis of colorectal origin treated by aggressive cytoreduction and hyperthermic intraperitoneal chemotherapy Br J Surg. 2004;91:739–46. CrossRef
- Verwaal VJ, van Ruth S, Witkamp A, Boot H, van Slooten G, Zoetmulder F. Long-term survival of peritoneal carcinomatosis of colorectal origin Ann Surg Oncol. 2005;12:65–71. CrossRef
- Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin Am Surg. 2000;66:561–8.
- Shen P, Levine EA, Hall J, et al. Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis Arch Surg. 2003;138:26–33. CrossRef
- Shen P, Hawksworth J, Lovato J, Loggie BW, Geisinger KR, Fleming RA, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma Ann Surg Oncol. 2004;11:178–86. CrossRef
- Levine EA, Stewart JH 4th, Russell GB, Geisinger KR, Loggie BL, Shen P. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures J Am Coll Surg. 2007;204(5):943–53; discussion 953–5. CrossRef
- Shen P, Thai K, Stewart JH, Howerton R, Loggie BW, Russell GB, et al. Peritoneal surface disease from colorectal cancer: comparison with the hepatic metastases surgical paradigm in optimally resected patients Ann Surg Oncol. 2008;15(12):3422–32. CrossRef
- Cavaliere F, Valle M, De Simone M, et al. 120 peritoneal carcinomatoses from colorectal cancer treated with peritonectomy and intra-abdominal chemohyperthermia: a S.I.T.I.L.O. multicentric study In Vivo. 2006;20(6A):747–50.
- Cavaliere F, Perri P, Di Filippo F, et al. Treatment of peritoneal carcinomatosis with intent to cure J Surg Oncol. 2000;74:41–4. CrossRef
- Cavaliere F, Di Filippo F, Botti C, et al. Peritonectomy and hyperthermic antiblastic perfusion in the treatment of peritoneal carcinomatosis Eur J Surg Oncol. 2000;26(5):486–91. CrossRef
- Hadi R, Saunders V, Utkina O, Clingan P, Kam P, Links M, et al. Review of patients with peritoneal malignancy treated with peritonectomy and heated intraperitoneal chemotherapy ANZ J Surg. 2006;76(3):156–61. CrossRef
- Yan TD, Chu F, Links M, Kam PC, Glenn D, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma: non-mucinous tumour associated with an improved survival Eur J Surg Oncol. 2006;32(10):1119–24. CrossRef
- Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg. 2008;248(5):829–35.
- Schneebaum S, Arnold MW, Staubus A, Young D, Dumond D, Martin EW. Intraperitoneal hyperthermic perfusion with mitomycin C for colorectal cancer with peritoneal metastases Ann Surg Oncol. 1996;3:44–50. CrossRef
- Pilati P, Mocellin S, Rossi CR, et al. Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma Ann Surg Oncol. 2003;10:508–13. CrossRef
- Kecmanovic DM, Pavlov MJ, Ceranic MS, Sepetkovski AV, Kovacevic PA, Stamenkovic AB. Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic perioperative intraperitoneal chemotherapy Eur J Surg Oncol. 2005;31:147–52. CrossRef
- Zanon C, Bortolini M, Chiappino I, et al. Cytoreductive surgery combined with intraperitoneal chemohyperthermia for the treatment of advanced colon cancer World J Surg. 2006;30(11):2025–32. CrossRef
- Roviello F, Marrelli D, Neri A, et al. Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity World J Surg. 2006;30(11):2033–40; discussion 2041–2. CrossRef
- Fuzun M, Sokmen S, Terzi C, Canda AE. Cytoreductive approach to peritoneal carcinomatosis originated from colorectal cancer: Turkish experience Acta Chirurgica Iugoslavica. 2006;53(2):17–21. CrossRef
- Kianmanesh R, Scaringi S, Sabate J, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases Ann Surg. 2007;245(4):597–603. CrossRef
- van Leeuwen BL, Graf W, Pahlman L, Mahteme H. Swedish experience with peritonectomy and HIPEC. HIPEC in peritoneal carcinomatosis Ann Surg Oncol. 2008;15(3):745–53. CrossRef
- Hansson J, Graf W, Påhlman L, Nygren P, Mahteme H. Postoperative adverse events and long-term survival after cytoreductive surgery and intraperitoneal chemotherapy Eur J Surg Oncol. 2009;35(2):202–8.
- Gusani NJ, Cho SW, Colovos C, et al. Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center Ann Surg Oncol. 2008;15(3):754–63. CrossRef
- Franko J, Gusani NJ, Holtzman MP, Ahrendt SA, Jones HL, Zeh HJ 3rd, et al. Multivisceral resection does not affect morbidity and survival after cytoreductive surgery and chemoperfusion for carcinomatosis from colorectal cancer Ann Surg Oncol. 2008;15(11):3065–72. CrossRef
- Ceelen WP, Peeters M, Houtmeyers P, et al. Safety and efficacy of hyperthermic intraperitoneal chemoperfusion with high-dose oxaliplatin in patients with peritoneal carcinomatosis Ann Surg Oncol. 2008;15(2):535–41. CrossRef
- Hagendoorn J, van Lammeren G, Boerma D, van der Beek E, Wiezer MJ, van Ramshorst B. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal and gastrointestinal origin shows acceptable morbidity and high survival Eur J Surg Oncol. 2008 [Epub ahead of print].
- Akaishi E, Teixeira F, Katayama M, Mizumoto N, Costa FP, Buzaid AC, et al. Peritonectomy for peritoneal carcinomatosis: long-term outcomes from a single Brazilian institution World J Surg. 2009;33(4):835–9. CrossRef
- Sugarbaker PH. Peritonectomy procedure Ann Surg. 1995;221:29–42.
- CEBM (2009) Levels of evidence. Oxford Centre for Evidence-Based Medicine. Available: http://www.cebm.net/index.aspx?o=1025 [Accessed: 25 March 2009].
- Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints Stat Med. 1998;17:2815–34. CrossRef
- Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis Stat Med. 2002;21:1539–58. CrossRef
- Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role Langenbecks Arch Surg. 1999;384:576–87. CrossRef
- Sugarbaker PH. Review of a personal experience in the management of carcinomatosis and sarcomatosis Jpn J Clin Oncol. 2001;31:573–83. CrossRef
- Koppe MJ, Boerman OC, Oyen W, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin incidence and current treatment strategies Ann Surg. 2006;243:212–22. CrossRef
- Yan TD, Bijelic L, Sugarbaker PH. Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms Ann Surg Oncol. 2007;14:2289–99. CrossRef
- Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer Cancer Chemother Pharmacol. 1999;43:S15–25. CrossRef
- Benoit L, Duvillard C, Rat P, Chauffert B. The effect of intra-abdominal temperature on the tissue and tumor diffusion of intraperitoneal cisplatin in a model of peritoneal carcinomatosis in rats Chirurgie. 1999;124:375. CrossRef
- Sugarbaker PH. Clinical research to standard of care: when does the transition occur? Ann Surg Oncol. 2003;10:825–6. CrossRef
- Lefor AT, Hughes KS, Shiloni E, et al. Intra-abdominal extrahepatic disease in patients with colorectal hepatic metastases Dis Colon Rectum. 1988;31:100–3. CrossRef
- A Systematic Review and Meta-Analysis of Cytoreductive Surgery with Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin
Annals of Surgical Oncology
Volume 16, Issue 8 , pp 2152-2165
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- 1. Department of Surgery, St George Hospital, The University of New South Wales, Sydney, NSW, Australia
- 2. Faculty of Health Sciences, University of Sydney, Camperdown, Australia