More Synchronous Peritoneal Disease but Longer Survival in Younger Patients with Carcinomatosis from Colorectal Cancer Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Colonoscopy to detect colorectal cancer (CRC) is recommended starting at age 50 years; however, CRC rates are increasing in the prescreening population. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been proven effective in select patients with peritoneal carcinomatosis (PC) from CRC, although it has not been evaluated specifically in patients < 50 years.
CRC patients aged < 50 years at diagnosis undergoing CRS/HIPEC 2007–2017 were compared with those aged ≥ 50 years. Age distribution was analyzed in patients undergoing colectomy alone versus CRS/HIPEC for CRC 1993–2013.
A total of 98 patients underwent CRS/HIPEC, of which 44% were < 50 years. Younger patients were more likely to present with synchronous peritoneal metastases (p = 0.050). Receipt of perioperative chemotherapy was comparable (p = not significant [NS]). Charlson Comorbidity Index and ECOG score were similar (p = NS). Tumor grade was similar (p = NS). Peritoneal Carcinomatosis Index, total organs resected, and anastomoses created were comparable (p = NS). Major Clavien-Dindo morbidity and LOS were similar (p = NS). Younger patients survived longer after CRS/HIPEC (p = 0.011). Demographic data from patients undergoing colectomy (n = 225) and CRS/HIPEC (n = 98) showed that age < 50 years was increasingly common with the more aggressive procedure (9% and 44% respectively, p < 0.001).
Younger patients with PC from CRC presented more often with peritoneal metastases at the time of diagnosis. Yet despite similar perioperative features at CRS/HIPEC, they survived longer than older patients. Patients undergoing CRS/HIPEC are overall younger than those undergoing index colectomy.
Conflict of interest
The authors declare no potential conflicts of interest.
- 1.Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. J Natl Cancer Inst. 2017;109.Google Scholar
- 2.National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology (NCCN Guidelines): Colorectal Cancer Screening. Version 2.2016; 2017.Google Scholar
- 3.U.S. Preventive Services Task Force. Screening for colorectal cancer: recommendation and rationale. Ann Intern Med. 2002;137:129–31.Google Scholar
- 8.Fu J, Yang J, Tan Y, et al. Young patients (≤35 years old) with colorectal cancer have worse outcomes due to more advanced disease: a 30-year retrospective review. Medicine (Baltimore). 2014;93.Google Scholar
- 13.Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17:1709–19.CrossRefGoogle Scholar
- 19.National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology (NCCN Guidelines): Colon Cancer. Version 2.2018;2018.Google Scholar
- 24.Turaga K, Levine E, Barone R, et al. Consensus guidelines from The American Society of Peritoneal Surface Malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States. Ann Surg Oncol. 2014;21:1501–5.CrossRefGoogle Scholar
- 28.Macrì A, Arcoraci V, Belgrano V, et al. Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: preliminary analysis of a multicentre study. Anticancer Res. 2014;34:5689–93.Google Scholar
- 29.Naffouje SA, Salti GI. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in elderly patients: complete cytoreduction is feasible and crucial for improved survival despite high carcinomatosis index. Anticancer Res. 2018;38:441–8.Google Scholar
- 30.Demey K, Wolthuis A, de Buck van Overstraeten A, et al. External Validation of the Prognostic Nomogram (COMPASS) for patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2017;24:3604–8.Google Scholar