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Perioperative and Oncological Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis of Rectal Origin

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Journal of Gastrointestinal Surgery Aims and scope

Abstract 

Background

The peritoneum is a common metastatic site of colorectal cancer (CRC) and associated with worse oncological outcomes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve outcomes in selected patients. Studies have demonstrated significant difference in survival of patients with primary colon and rectal tumors both in local and in metastatic setting; but only few assessed outcomes of CRS/HIPEC for rectal and colon tumors. We studied the perioperative and oncological outcomes of patients undergoing CRS/HIPEC for rectal cancer.

Methods

A retrospective analysis of a prospectively maintained database between 2009 and 2021 was performed.

Results

199 patients underwent CRS/HIPEC for CRC. 172 patients had primary colon tumors and 27 had primary rectal tumors. Primary rectal location was associated with longer surgery (mean 4.32, hours vs 5.26 h, p = 0.0013), increased blood loss (mean 441cc vs 602cc, p = 0.021), more blood transfusions (mean 0.77 vs 1.37units, p = 0.026) and longer hospitalizations (mean 10 days vs 13 days, p = 0.02). Median disease-free survival (DFS) was shorter in rectal primary group; 7.03 months vs 10.9 months for colon primaries (p = 0.036). Overall survival was not statistically significant; 53.2 months for rectal and 60.8 months for colon primary tumors. Multivariate analysis indicated origin (colon vs rectum) and Peritoneal Cancer Index to be independently associated with DFS.

Conclusions

Patients with rectal carcinoma undergoing CRS/HIPEC for peritoneal metastasis had worse peri-operative and oncological outcomes. Overall survival was excellent in both groups. This data may be used for risk stratification when considering CRS/HIPEC for patients with rectal primary.

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Author notes

  1. Mai Shiber, Almog Ben-Yaacov and Mohammad Adileh contributed equally to the manuscript.

Authors and Affiliations

  1. Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel

    Haggai Benvenisti MD, Mai Shiber BSc, Dan Assaf MD, Yehuda Shovman MD, Shachar Laks MD, Nadav Elbaz MD, Eyal Mor MD, Douglas Zippel MD, Aviram Nissan MD, Almog Ben-Yaacov MD & Mohammad Adileh MD

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Haggai Benvenisti MD, Mai Shiber BSc, Dan Assaf MD, Yehuda Shovman MD, Shachar Laks MD, Nadav Elbaz MD, Eyal Mor MD, Douglas Zippel MD, Aviram Nissan MD, Almog Ben-Yaacov MD & Mohammad Adileh MD

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  1. Haggai Benvenisti MD
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Contributions

Haggai Benvenisti- Conception, data collection and analysis, writing, editing, Mai Shiber- Data collection, writing. Dan Assaf- Data collection, editing, statistical analysis. Yehuda Shovman: Data analysis, manuscript writing. Schachar Laks: Manuscript writing / editing. Nadav Elbaz: Data collection, editing Eyal Mor: Conception, data collection, manuscript editing. Douglas Zippel: Manuscript writing / editing. Aviram Nissan: Protocol/project development, data collection, data analysis, manuscript editing. Almog Ben-Yaacov: Protocol/project development, data collection, data analysis, manuscript editing. Mohammad Adileh: Protocol/project development, data collection, data analysis, manuscript editing.

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Correspondence to Haggai Benvenisti MD.

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Benvenisti, H., Shiber, M., Assaf, D. et al. Perioperative and Oncological Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis of Rectal Origin. J Gastrointest Surg 27, 2506–2514 (2023). https://doi.org/10.1007/s11605-023-05833-3

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