Management for Peritoneal Metastasis of Colonic Origin: Role of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy: A Single Institution’s Experience During Two Decades
Peritoneal metastasis of colonic origin is associated with a poor prognosis. This study aimed to analyze the clinicopathologic characteristics and prognostic predictors of survival in a cohort of patients treated with cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (POIC) during two decades.
A retrospective study analyzed a prospectively maintained database for all patients treated for peritoneal metastasis of a colonic origin (PCC) from January 1990 to April 2015.
The 318 patients in our study comprised 171 men (53.8%) and 147 women (46.2%). The mean age of the patients at presentation was 50.6 years, (range 18–86 years). Overall survival was 42.5%, median survival and follow-up time was 21.5 and 15.0 months respectively. The 3 and 5 years survival rates were respectively 35 and 25%. The median survival time was 20.6 months for the men and 23.1 months for the women (p = 0.14). The mean intraoperative peritoneal carcinomatosis index (PCI) was 15.2. The patients who had a completeness of cytoreduction (CC) score of 0 or 1 (no residual disease <0.25 mm) had a median survival time of 36.6 months compared with 18.3 months for the patients with a CC-2 score and 7.6 months for the patients with a CC-3 score (p < 0.000). The significant independent predictors of survival in the multivariate analysis were the CC score and elevated tumor makers CA153 and CA125.
For patients with a limited extent of peritoneal metastases, CC is the most important prognostic variable for improved survival of colon cancer patients with peritoneal metastases.
KeywordsPeritoneal Metastasis Cytoreductive Surgery Intraperitoneal Chemotherapy Peritoneal Cancer Index Complete Cytoreduction
- 1.Howlader N, Noone AM, Krapcho M, et al (eds). SEER cancer statistics review, 1975–2010. National Cancer Institute, Bethesda 2013.Google Scholar
- 10.Sugarbaker PH. An overview of peritonectomy, visceral resections, and perioperative chemotherapy for peritoneal surface malignancy. In: Sugarbaker PH (ed) Cytoreductive surgery & perioperative chemotherapy for peritoneal surface malignancy (textbook and video atlas). Cine-Med Publishing, Woodbury, CT, 2012, pp 1–30.Google Scholar
- 12.Jacquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal metastasis. J Exp Clin Cancer Res. 1996;15:49–58.Google Scholar
- 15.Elias D, Mariani A, Cloutier AS, Blot F, Goéré D, Dumont F, et al. Modified selection criteria for complete cytoreductive surgery plus HIPEC based on peritoneal cancer index and small bowel involvement for peritoneal carcinomatosis of colorectal origin. Eur J Surg Oncol. 2014a;40:1467–73.CrossRefPubMedGoogle Scholar
- 19.Elias D, Gilly F, Boutitie F, Quenet F, Bereder JM, Masvelt B, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8.CrossRefPubMedGoogle Scholar
- 20.Froysnes I, Larsen S, Spasojevic M, et al. Complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastasis in Norway: prognostic factors and oncologic outcome in a national patient cohort. J Surg Oncol. 2016. DOI: 10.1002/jso.24290.PubMedGoogle Scholar