Surgical Treatment of Colorectal Cancer with Peritoneal and Liver Metastases Using Combined Liver and Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Report from a Single-Centre Experience
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Chemotherapeutic advances have enabled successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) expansion in treating metastatic colorectal cancer.
The aims of this study were to evaluate the safety of combining liver surgery (LS) with HIPEC and CRS (which remains controversial) and its impact on overall survival (OS) rates.
From 2007 to 2015, a total of 77 patients underwent CRS/HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer. Twenty-five of these patients underwent concomitant LS for suspicion of liver metastases (LM; group 2), and were compared with patients who underwent CRS/HIPEC only (group 1). Demographic and clinical data were reviewed retrospectively.
Among the group 2 patients, two underwent major hepatectomies, six underwent multiple wedge resections, 16 underwent single wedge resections (one with radiofrequency ablation), and one underwent radiofrequency ablation alone. For groups 1 and 2, median peritoneal cancer index was 6 and 10 (range 0–26; p = 0.08), complication rates were 15.4 and 32.0 % (Dindo–Clavien ≥3; p = 0.15), and median follow-up was 34.2 and 25.5 months (range 0–75 and 3–97), respectively. One group 2 patient died of septic shock after 66 days. Pathology confirmed LM in 21 patients in group 2 (four with benign hepatic lesions were excluded from long-term outcome analysis). Two-year OS rates were 89.5 and 70.2 % (p = 0.04), and 2-year recurrence-free survival rates were 38.3 and 13.4 % (p = 0.01) in groups 1 and 2, respectively.
Simultaneous surgery for colorectal LM and PC is both feasible and safe, with low postoperative morbidity. Further longer-term studies would help determine its impact on patient survival.
KeywordsOverall Survival Liver Metastasis Peritoneal Carcinomatosis Colorectal Liver Metastasis Major Hepatectomy
The authors are most grateful to Dr. Claire de Burbure-Craddock for revising the manuscript.
Conflicts of Interest
Julie Navez, Christophe Remue, Daniel Leonard, Radu Bachmann, Alex Kartheuser, Catherine Hubert, Laurent Coubeau, Mina Komuta, Marc Van den Eynde, Francis Zech, and Nicolas Jabbour declare no conflicts of interest.
- 10.de Cuba EM, Kwakman R, Knol DL, Bonjer HJ, Meijer GA, Te Velde EA. Cytoreductive surgery and HIPEC for peritoneal metastases combined with curative treatment of colorectal liver metastases: systematic review of all literature and meta-analysis of observational studies. Cancer Treat Rev. 2013;39(4):321–7.CrossRefPubMedGoogle Scholar
- 12.Nurminen M, Mutanen P. Exact Bayesian analysis of two proportions. Scand J Stat. 1987;14: 67–77.Google Scholar
- 14.Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.1, cancer incidence and mortality worldwide: IARC CancerBase no. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2014. http://globocan.iarc.fr, Accessed on 16 Jan 2015.
- 18.Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240(6):1037–49.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Interv Radiol. 2005;16(6):779–90. [Review].Google Scholar
- 25.Lord AC, Shihab O, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ. Recurrence and outcome after complete tumour removal and hyperthermic intraperitoneal chemotherapy in 512 patients with pseudomyxoma peritonei from perforated appendiceal mucinous tumours. Eur J Surg Oncol. 2015;41(3):396–9.CrossRefPubMedGoogle Scholar
- 29.Alzahrani N, Ung L, Valle SJ, Liauw W, Morris DL. Synchronous liver resection with cytoreductive surgery for the treatment of liver and peritoneal metastases from colon cancer: results from an Australian centre. ANZ J Surg. 2015. doi: 10.1111/ans.13231 [Epub ahead of print].
- 36.Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14(12):1208–15.CrossRefPubMedGoogle Scholar