Annals of Surgical Oncology

, Volume 23, Supplement 5, pp 666–673 | Cite as

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

  • Julie Navez
  • Christophe Remue
  • Daniel Leonard
  • Radu Bachmann
  • Alex Kartheuser
  • Catherine Hubert
  • Laurent Coubeau
  • Mina Komuta
  • Marc Van den Eynde
  • Francis Zech
  • Nicolas Jabbour
Colorectal Cancer



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.


Overall Survival Liver Metastasis Peritoneal Carcinomatosis Colorectal Liver Metastasis Major Hepatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


  1. 1.
    Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89:1545–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg. 2006;243(2):212–22.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ismaili N. Treatment of colorectal liver metastases. World J Surg Oncol. 2011;9:154.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lee WS, Yun SH, Chun HK, et al. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis. 2007;22(6):699–704.CrossRefPubMedGoogle Scholar
  5. 5.
    Jones RP, Jackson R, Dunne DF, Malik HZ, Fenwick SW, Poston GJ, et al. Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases. Br J Surg. 2012;99(4):477–86.CrossRefPubMedGoogle Scholar
  6. 6.
    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(2):178–86.CrossRefPubMedGoogle Scholar
  7. 7.
    Thomassen I, van Gestel YR, Lemmens VE, de Hingh IH. Incidence, prognosis, and treatment options for patients with synchronous peritoneal carcinomatosis and liver metastases from colorectal origin. Dis Colon Rectum. 2013;56(12):1373–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Elias D, Benizri E, Pocard M, Ducreux M, Boige V, Lasser P. Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol. 2006;32(6):632–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Varban O, Levine EA, Stewart JH, McCoy TP, Shen P. Outcomes associated with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy in colorectal cancer patients with peritoneal surface disease and hepatic metastases. Cancer. 2009;115(15):3427–36.CrossRefPubMedGoogle Scholar
  10. 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
  11. 11.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Nurminen M, Mutanen P. Exact Bayesian analysis of two proportions. Scand J Stat. 1987;14: 67–77.Google Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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., Accessed on 16 Jan 2015.
  15. 15.
    Loupakis F, Cremolini C, Masi G, et al. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med. 2014;371(17):1609–18.CrossRefPubMedGoogle Scholar
  16. 16.
    Cushman SM, Jiang C, Hatch AJ, et al. Gene expression markers of efficacy and resistance to cetuximab treatment in metastatic colorectal cancer: results from CALGB 80203 (Alliance). Clin Cancer Res. 2015;21(5):1078–86.CrossRefPubMedGoogle Scholar
  17. 17.
    Luo LX, Yu ZY, Huang JW, Wu H. Selecting patients for a second hepatectomy for colorectal metastases: an systemic review and meta-analysis. Eur J Surg Oncol. 2014;40(9):1036–48.CrossRefPubMedGoogle Scholar
  18. 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. 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
  20. 20.
    Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg. 1999;230(1):1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Brooks AJ, Wang F, Alfredson M, Yan TD, Morris DL. Synchronous liver resection and cryotherapy for colorectal metastases: survival analysis. Surgeon. 2005;3(4):265–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255(3):405–14.CrossRefPubMedGoogle Scholar
  23. 23.
    Hagness M, Foss A, Line PD, et al. Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg. 2013;257(5):800–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Mulier S, Claes JP, Dierieck V, et al. Survival benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) at the different time-points of treatment of ovarian cancer: review of evidence. Curr Pharm Des.2012;18(25):3793–803.CrossRefPubMedGoogle Scholar
  25. 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
  26. 26.
    Abreu de Carvalho LF, Scuderi V, Maes H, et al. Simultaneous parenchyma-preserving liver resection, cytoreductive surgery and intraperitoneal chemotherapy for stage IV colorectal cancer. Acta Chir Belg. 2015;115(4):261–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Maggiori L, Goéré D, Viana B, et al. Should patients with peritoneal carcinomatosis of colorectal origin with synchronous liver metastases be treated with a curative intent? A case-control study. Ann Surg. 2013;258(1):116–21.PubMedGoogle Scholar
  28. 28.
    Berger Y, Aycart S, Tabrizian P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with liver involvement. J Surg Oncol. 2016;113(4):432–7.CrossRefPubMedGoogle Scholar
  29. 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].
  30. 30.
    Delhorme JB, Dupont-Kazma L, Addeo P, et al. Peritoneal carcinomatosis with synchronous liver metastases from colorectal cancer: Who will benefit from complete cytoreductive surgery? Int J Surg. 2016;25:98–105.CrossRefPubMedGoogle Scholar
  31. 31.
    Glockzin G, Renner P, Popp FC, Dahlke MH, von Breitenbuch P, Schlitt HJ, et al. Hepatobiliary procedures in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2011;18(4):1052–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Sugarbaker PH, Ryan DP. Cytoreductive surgery plus hyperthermic perioperative chemotherapy to treat peritoneal metastases from colorectal cancer: standard of care or an experimental approach? Lancet Oncol. 2012;13(8):e362–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Elias D, Faron M, Goéré D, et al. A simple tumor load-based nomogram for surgery in patients with colorectal liver and peritoneal metastases. Ann Surg Oncol. 2014;21(6):2052–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Chua TC, Yan TD, Zhao J, Morris DL. Peritoneal carcinomatosis and liver metastases from colorectal cancer treated with cytoreductive surgery perioperative intraperitoneal chemotherapy and liver resection. Eur J Surg Oncol. 2009;35(12):1299–1305.CrossRefPubMedGoogle Scholar
  35. 35.
    Désolneux G, Mazière C, Vara J, et al. Cytoreductive surgery of colorectal peritoneal metastases: outcomes after complete cytoreductive surgery and systemic chemotherapy only. PLoS One. 2015;10(3):e0122816.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 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
  37. 37.
    Esquivel J. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: survival outcomes and patient selection. J Gastrointest Oncol. 2016;7(1):72–8.PubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Julie Navez
    • 1
    • 2
  • Christophe Remue
    • 2
  • Daniel Leonard
    • 2
  • Radu Bachmann
    • 2
  • Alex Kartheuser
    • 2
  • Catherine Hubert
    • 1
  • Laurent Coubeau
    • 1
  • Mina Komuta
    • 3
  • Marc Van den Eynde
    • 4
  • Francis Zech
    • 5
  • Nicolas Jabbour
    • 1
  1. 1.Hepatobiliary Surgery Unit, Department of Abdominal Surgery and TransplantationCliniques Universitaires Saint-Luc, Université Catholique de LouvainBrusselsBelgium
  2. 2.Colorectal Surgery Unit, Department of Abdominal Surgery and TransplantationCliniques Universitaires Saint-Luc, Université Catholique de LouvainBrusselsBelgium
  3. 3.Department of PathologyCliniques Universitaires Saint-Luc, Université Catholique de LouvainBrusselsBelgium
  4. 4.Department of Medical OncologyCliniques Universitaires Saint-Luc, Université Catholique de LouvainBrusselsBelgium
  5. 5.Department of Internal MedicineCliniques Universitaires Saint-Luc, Université Catholique de LouvainBrusselsBelgium

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