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Factors affecting R0 resection of colorectal cancer with synchronous peritoneal metastases: a multicenter prospective observational study by the Japanese Society for Cancer of the Colon and Rectum

  • Dai ShidaEmail author
  • Hirotoshi Kobayashi
  • Masao Kameyama
  • Kazuo Hase
  • Kotaro Maeda
  • Takeshi Suto
  • Michio Itabashi
  • Kimihiko Funahashi
  • Fumikazu Koyama
  • Heita Ozawa
  • Shingo Noura
  • Hideyuki Ishida
  • Yukihide Kanemitsu
  • Kenjiro Kotake
  • Kenichi Sugihara
Original Article
  • 33 Downloads

Abstract

Background

In Japan, R0 resection has been recommended for colorectal cancer patients with peritoneal metastases confined to the adjacent peritoneum and those with a few metastases to the distant peritoneum. R0 resection for M1c disease has drawn attention in Western countries and is currently considered an acceptable therapeutic option in the US National Comprehensive Cancer Network guidelines. However, clinical factors that affect the choice of R0 resection are unknown.

Methods

This multicenter, prospective, observational study was conducted by the Japanese Society for Cancer of the Colon and Rectum. Colorectal cancer patients with synchronous peritoneal metastases were enrolled at 28 institutions in Japan from October 2012 to December 2016. To determine factors affecting R0 resection and R1 resection with intended R0 resection, stepwise logistic regression analyses were performed on clinical factors including age, sex, performance status (PS), body mass index, peritoneal cancer index (PCI) score, presence of ascites, presence of distant metastases, and primary tumor site.

Results

R0/R1 resection was performed in 36 (31/5; 25%) of 146 patients. No distant metastases [odds ratio (OR) 52.9; 95% confidence interval (CI) 13.3–210.1; p < 0.0001], low PCI score (1–6) (OR 20.0; 95% CI 4.8–83.4; p < 0.0001), and high PS (0) (OR 2.40; 95% CI 0.66–8.68; p = 0.18) were independent factors affecting R0/R1 resection. PCI score and PS were also independent factors affecting R0/R1 resection in M1c patients without non-peritoneal distant metastases (n = 59).

Conclusion

Distant metastases, PCI score, and PS are three factors which affect R0 resection for M1c disease.

Keywords

Peritoneal metastasis Colorectal cancer R0 resection Peritoneal cancer index score 

Abbreviations

AUC

Area under the curve

CI

Confidence interval

CRC

Colorectal cancer

HIPEC

Hyperthermic intraperitoneal chemotherapy

NCCN

National Comprehensive Cancer Network

OR

Odds ratio

OS

Overall survival

PCI

Peritoneal cancer index

PS

Performance status

ROC

Receiver operating characteristic

TNM classification

Tumor-node-metastasis classification

Notes

Acknowledgements

This study is based on data collected from 28 hospitals participating in a multicenter, prospective, observational study of CRC with synchronous peritoneal metastases conducted by the JSCCR. We thank all the participating patients and their families, as well as investigators and operation staff members. We also thank Masamichi Yasuno (Tokyo Medical and Dental University), Masayuki Ohue (Osaka International Cancer Institute), Hideo Yano (National Center for Global Health and Medicine), Soichiro Ishihara (University of Tokyo), Keiji Koda (Teikyo University Chiba Medical Center), Hirotoshi Kobayashi (Tokyo Metropolitan Hiroo Hospital), Fumio Baba (Kumamoto University), Yoshiharu Sakai (Kyoto University), Yojiro Hashiguchi (Teikyo University), Akio Yamaguchi (University of Fukui), Masato Kusunoki (Mie University), Naohiro Tomita (Hyogo College of Medicine), Tadahiko Masaki (Kyorin University), Yoshito Akagi (Kurume University), Mitsuyoshi Ota (Yokohama City University Medical Center), Kenichi Hakamada (Hirosaki University), and Yasuhiro Kodera (Nagoya University).

Funding

None to report.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Dai Shida
    • 1
    Email author
  • Hirotoshi Kobayashi
    • 2
  • Masao Kameyama
    • 3
  • Kazuo Hase
    • 4
  • Kotaro Maeda
    • 5
  • Takeshi Suto
    • 6
  • Michio Itabashi
    • 7
  • Kimihiko Funahashi
    • 8
  • Fumikazu Koyama
    • 9
  • Heita Ozawa
    • 10
  • Shingo Noura
    • 11
  • Hideyuki Ishida
    • 12
  • Yukihide Kanemitsu
    • 1
  • Kenjiro Kotake
    • 13
  • Kenichi Sugihara
    • 14
  1. 1.Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
  2. 2.Department of SurgeryTeikyo University Mizonokuchi HospitalKawasakiJapan
  3. 3.Department of SurgeryBell Land General HospitalSakaiJapan
  4. 4.National Defense Medical CollegeTokorozawaJapan
  5. 5.International Medical CenterFujita Health University HospitalToyoakeJapan
  6. 6.Department of Gastroenterological SurgeryYamagata Prefectural Central HospitalYamagataJapan
  7. 7.Department of Surgery, Institute of GastroenterologyTokyo Women’s Medical UniversityTokyoJapan
  8. 8.Department of General and Gastroenterological SurgeryToho University Omori Medical CenterTokyoJapan
  9. 9.Department of SurgeryNara Medical UniversityKashiharaJapan
  10. 10.Department of SurgeryTochigi Cancer CenterUtsunomiyaJapan
  11. 11.Department of SurgeryOsaka Rosai HospitalSakaiJapan
  12. 12.Department of Digestive Tract and General SurgerySaitama Medical Center, Saitama Medical UniversityKawagoeJapan
  13. 13.Department of Gastroenterology and SurgerySano City HospitalSanoJapan
  14. 14.Tokyo Medical and Dental UniversityTokyoJapan

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