Annals of Surgical Oncology

, Volume 21, Issue 8, pp 2667–2674 | Cite as

Metastatic Colorectal Cancer: Survival Comparison of Hepatic Resection Versus Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Aaron U. Blackham
  • Gregory B. Russell
  • John H. StewartIV
  • Konstantinos Votanopoulos
  • Edward A. Levine
  • Perry Shen
Colorectal Cancer

Abstract

Background

Liver resection has long been considered the standard of care for resectable colorectal hepatic metastases (HM). Patients with colorectal peritoneal surface disease (PSD) are now also being treated with aggressive therapy in the form of cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

A retrospective comparison of optimally-treated colorectal cancer patients with HM or PSD obtained from prospectively maintained databases (1991–2010).

Results

Liver resection was performed on 179 patients with HM, while 93 PSD patients received a complete cytoreduction followed by HIPEC. Patients differed in terms of age, performance status, site of primary cancer, T stage, and the use of perioperative chemotherapy. Five-year overall survival for HM patients was 36 %, with a median survival of 46 months, compared with 26 % and 34 months in patients with PSD (p = 0.024). When stratified by resection status, R0 HM (n = 170) and R0 PSD (n = 48) patients had similar median survival (49 vs. 41 months; p = 0.39). Median survival following R1 resection was also similar among HM (n = 9) and PSD (n = 45) patients (28 vs. 23 months; p = 0.68). Multivariate analysis identified distinctly different independent prognostic factors between HM and PSD patients. Major morbidity was 21 and 23 % (p = 0.88), while mortality was 3.9 versus 5.4 % (p = 0.55) in the HM and PSD patients, respectively.

Conclusion

Colorectal HM and PSD are distinct biologic diseases with different presentations and unique prognostic factors. However, long-term survival following CS/HIPEC is comparable to liver resection when stratified by completeness of resection. Furthermore, perioperative morbidity and mortality are similar.

Notes

Financial Disclaimers

Nothing to disclose.

Supplementary material

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Supplementary material 1 (DOCX 13 kb)
10434_2014_3563_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 20 kb)
10434_2014_3563_MOESM3_ESM.docx (20 kb)
Supplementary material 3 (DOCX 20 kb)

References

  1. 1.
    Eisenberg B, Decosse JJ, Harford F, et al. Carcinoma of the colon and rectum: the natural history reviewed in 1704 patients. Cancer. 1982;49(6):1131–1134.PubMedCrossRefGoogle Scholar
  2. 2.
    Dawson LE, Russell AH, Tong D, et al. Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone. J Surg Oncol. 1983;22(2):95–99.PubMedCrossRefGoogle Scholar
  3. 3.
    Bergmark S, Hafström L. The natural history of primary and secondary malignant tumors of the liver. I: the prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer 1969;23(1):198–202.CrossRefGoogle Scholar
  4. 4.
    Bengtsson G, Carlsson G, Hafstrom L, et al. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141(5):586–589.PubMedCrossRefGoogle Scholar
  5. 5.
    Finlay IG, Mcardle CS. Occult hepatic metastases in colorectal carcinoma. Br J Surg 1986;73(9):732–735.PubMedCrossRefGoogle Scholar
  6. 6.
    (6) Bozzetti F, Bignami P, Morabito A, et al. Patterns of failure following surgical resection of colorectal cancer liver metastases: rationale for a multimodal approach. Ann Surg. 1987; 205(3):264–270.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Gertsch P: A historical perspective on colorectal liver metastases and peritoneal carcinomatosis: similar results, different treatments. Surg Oncol Clin N Am 2003;12:531–541.PubMedCrossRefGoogle Scholar
  8. 8.
    de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250(3):440–448.PubMedGoogle Scholar
  9. 9.
    Steele G, Ravikumar TS. Resection of hepatic metastases from colorectal cancer biologic perspectives. Ann Surg. 1989;210(2):127–138.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Scheele J, Stang R, Altendorfhofmann A, et al. Resection of colorectal liver metastases. World J Surg. 1995;19(1):59–71.PubMedCrossRefGoogle Scholar
  11. 11.
    Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235(6):759–765.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Wei AC, Greig PD, Grant D, et al. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol. 2006;13(5):668–676.PubMedCrossRefGoogle Scholar
  13. 13.
    Wang X, Hershman DL, Abrams JA, et al. Predictors of survival after hepatic resection among patients with colorectal liver metastasis. Br J Cancer. 2007;97(12):1606–1612.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Figueras J, Torras J, Valls C, et al. Surgical resection of colorectal liver metastases in patients with expanded indications: a single-center experience with 501 patients. Dis Colon Rectum. 2007;50(4):478–488.PubMedCrossRefGoogle Scholar
  15. 15.
    Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–4580.PubMedCrossRefGoogle Scholar
  16. 16.
    Minagawa M, Yamamoto J, Kosuge T, et al. Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation. Arch Surg. 2007;142(3):269–276.PubMedCrossRefGoogle Scholar
  17. 17.
    Rees M, Tekkis PP, Welsh FKS, et al. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247(1):125–135.PubMedCrossRefGoogle Scholar
  18. 18.
    Nathan H, de Jong MC, Pulitano C, et al. Conditional survival after surgical resection of colorectal liver metastasis: an international multi-institutional analysis of 949 patients. J Am Coll Surg. 2010;210(5):755–764.PubMedCrossRefGoogle Scholar
  19. 19.
    Jamison RL, Donohue JH, Nagorney DM, et al. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg. 1997;132(5):505–510.PubMedCrossRefGoogle Scholar
  20. 20.
    Pawlik TM, Scoggins CR, Zorzi D, et al: Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241(5):715–724.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77(7):1254–1262.PubMedCrossRefGoogle Scholar
  22. 22.
    Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer; analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–318.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    McKay A, Fradette K, Lipschitz J. Long-term outcomes following hepatic resection and radiofrequency ablation of colorectal liver metastases. HPB Surg. 2009:2009:346963.CrossRefGoogle Scholar
  24. 24.
    Fernandez FG, Drebin JA, Linehan DC, et al. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg. 2004;240(3):438–447.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Saito Y, Omiya H, Kohno K, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg. 2002;124(5):1007–1013.PubMedCrossRefGoogle Scholar
  26. 26.
    Welter S, Jacobs J, Krbek T, et al. Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg. 2007;84(1):203–210.PubMedCrossRefGoogle Scholar
  27. 27.
    Mahmoud N, Dunn KB. Metastasectomy for stage IV colorectal cancer. Dis Colon Rectum. 2010;53(7):1080–1092.PubMedCrossRefGoogle Scholar
  28. 28.
    Chu DZJ, Lang NP, Thompson C, et al. Peritoneal carcinomatosis in nongynecologic malignancy: a prospective-study of prognostic factors. Cancer. 1989;63(2):364–367.PubMedCrossRefGoogle Scholar
  29. 29.
    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(16):3284–3292.PubMedCrossRefGoogle Scholar
  30. 30.
    Knorr C, Reingruber B, Meyer T, et al. Peritoneal carcinomatosis of colorectal cancer: incidence, prognosis, and treatment modalities. Int J Colorectal Dis. 2004;19(3):181–187.PubMedCrossRefGoogle Scholar
  31. 31.
    Pestieau SR, Sugarbaker PH. Treatment of primary colon cancer with peritoneal carcinomatosis: comparison of concomitant vs. delayed management. Dis Colon Rectum. 2000;43(10):1341–1346.PubMedCrossRefGoogle Scholar
  32. 32.
    Glehen J, Cotte E, Schreiber V, et al. Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg. 2004;91(6):747–754.PubMedCrossRefGoogle Scholar
  33. 33.
    Verwaal VJ, van Ruth S, Witkamp A, et al. Long-term survival of peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2005;12(1):65–71.PubMedCrossRefGoogle Scholar
  34. 34.
    Kianmanesh R, Scaringi S, Sabate JM, 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.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    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):829–835.PubMedGoogle Scholar
  36. 36.
    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(1):71–76.PubMedCrossRefGoogle Scholar
  37. 37.
    Shen P, Hawksworth J, Lovato J, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol. 2004;11(2):178–186.PubMedCrossRefGoogle Scholar
  38. 38.
    Elias D, Glehen O, Pocard M, et al. A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg. 2010;251(5):896–901.PubMedCrossRefGoogle Scholar
  39. 39.
    Cavaliere F, De Simone M, Virzi S, et al. Prognostic factors and oncologic outcome in 146 patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: Italian multicenter study S.I.T.I.L.O. Eur J Surg Oncol. 2011;37(2):148–154.PubMedCrossRefGoogle Scholar
  40. 40.
    Verwaal VJ, Bruin S, Boot H, et al. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 2008;15(9):2426–2432.PubMedCrossRefGoogle Scholar
  41. 41.
    Shen P, Thai K, Stewart JH, 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):3422–3432.PubMedCrossRefGoogle Scholar
  42. 42.
    Cao CQ, Yan TD, Liauw W, et al. comparison of optimally resected hepatectomy and peritonectomy patients with colorectal cancer metastasis. J Surg Oncol. 2009;100(7):529–533.PubMedCrossRefGoogle Scholar
  43. 43.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240(2):205–213.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    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):681–685.PubMedCrossRefGoogle Scholar
  45. 45.
    Franko J, Ibrahim Z, Gusani NJ, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116(16):3756–3762.PubMedCrossRefGoogle Scholar
  46. 46.
    Franko J, Shi Q, Goldman CD, et al. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of North Center Cancer Treatment Group phase III trials N9741 and N9841. J Clin Oncol. 2012;30(3): 263–267.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Sugarbaker P. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 1998;14(3):254–261.PubMedCrossRefGoogle Scholar
  48. 48.
    Jacquet P, Averbach A, Stephens AD, et al. Heated intraoperative intraperitoneal mitomycin C and early postoperative intraperitoneal 5-fluorouracil: pharmacokinetic studies. Oncology. 1998;55(2):130–138.PubMedCrossRefGoogle Scholar
  49. 49.
    Flessner MF. The transport barrier in intraperitoneal therapy. Am J Physiol Renal Physiol. 2005;288(3):F433–F442.PubMedCrossRefGoogle Scholar
  50. 50.
    Sticca RP, Dach BW. Rationale for hyperthermia with intraoperative intraperitoneal chemotherapy agents. Surg Oncol Clin N Am 2003;12(3):689–701.PubMedCrossRefGoogle Scholar
  51. 51.
    Los G, Smals OAG, Vanvugt MJH, et al. A rationale for carboplatin treatment and abdominal hyperthermia in cancers restricted to the peritoneal cavity. Cancer Res. 1992;52(5):1252–1258.PubMedGoogle Scholar
  52. 52.
    Koga S, Hamazoe R, Maeta M, et al. Treatment of implanted peritoneal cancer in rats by continuous hyperthermic peritoneal perfusion in combination with an anticancer drug. Cancer Res. 1984;44(5):1840–1842.PubMedGoogle Scholar
  53. 53.
    Scheele J, Altendorf-Hofmann A. Surgical treatment of liver metastases. In: Blumgart LH (ed). Surgery of the liver and biliary tract. 3rd ed. London: WB Saunders, 2000:1475–1502.Google Scholar
  54. 54.
    Vetto JT, Hughes KS, Rosenstein R, et al. Morbidity and mortality of hepatic resection for metastatic colorectal carcinoma. Dis Colon Rectum 1990;33(5):408–413.PubMedCrossRefGoogle Scholar
  55. 55.
    Nordlinger B, Parc R, Delva E, et al. Hepatic resection for colorectal liver metastases influence on survival of preoperative factors and surgery for recurrences in 80 patients. Ann Surg. 1987;205(3):256–263.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Holm A, Bradley E, Aldrete JS. Hepatic resection of metastasis from colorectal carcinoma morbidity, mortality, and pattern of recurrence. Ann Surg. 1989;209(4):428–434.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Kortz WJ, Meyers WC, Hanks JB, et al. Hepatic resection for metastatic cancer. Ann Surg. 1984;199(2):182–186.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Olak J, Wexler MJ, Rodriguez J, et al. Hepatic resection for metastatic disease. Can J Surg. 1986;29(6):435–439.PubMedGoogle Scholar
  59. 59.
    Bradpiece HA, Benjamin IS, Halevy A, et al. Major hepatic resection for colorectal liver metastases. Br J Surg. 1987;74(4):324–326.PubMedCrossRefGoogle Scholar
  60. 60.
    House MG, Ito H, Gonen M, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210(5):744–752.PubMedCrossRefGoogle Scholar
  61. 61.
    Smeenk RM, Verwaal VJ, Zoetmulder FN. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007;94(11):1408–1414.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Aaron U. Blackham
    • 1
  • Gregory B. Russell
    • 2
  • John H. StewartIV
    • 1
  • Konstantinos Votanopoulos
    • 1
  • Edward A. Levine
    • 1
  • Perry Shen
    • 1
  1. 1.Department of General Surgery, Surgical Oncology SectionWake Forest School of MedicineWinston-SalemUSA
  2. 2.Biostatistical SciencesWake Forest School of MedicineWinston-SalemUSA

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