Skip to main content

Advertisement

SpringerLink
Log in

Predictors of Progression in High-Grade Appendiceal or Colorectal Peritoneal Carcinomatosis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Regional Cancer Therapies
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Long-term survival of patients with appendiceal or colorectal peritoneal carcinomatosis (PC) may be achieved by combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Unfortunately, such favorable outcomes are realized in a minority of patients. Given the morbidity of the CRS/HIPEC and the uncertain role of postresection systemic therapy, it is important that prognostic factors in high-grade PC be clearly defined.

Methods

This single center, retrospective, cohort study examined the outcomes of CRS/HIPEC performed on patients with high-grade PC secondary to appendiceal or colorectal adenocarcinoma between 2007 and 2013. Cox regression analysis was utilized to evaluate the association between potential prognostic factors [age, sex, primary site, lymph node (LN) status, peritoneal cancer index (PCI) score, completeness of cytoreduction score (CC score), number of visceral resections, and systemic chemotherapy] and progression-free survival (PFS).

Results

A total of 70 patients with high-grade appendiceal or colorectal PC underwent CRS/HIPEC during the study period; 82.9 % underwent complete (CC-0) cytoreduction with a median PFS of 9.7 months. Positive LNs at the time of CRS/HIPEC were predictors of worse PFS on univariate and multivariate analysis. No association was demonstrated between pre- or post-HIPEC systemic chemotherapy and PFS.

Conclusions

High-grade PC secondary to appendiceal or colorectal adenocarcinoma can be managed with CRS/HIPEC. The number of LN metastases at the time of CRS/HIPEC is the strongest predictor of progression and must be considered when determining patient eligibility for this aggressive treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sugarbaker PH. Patient selection and treatment of peritoneal carcinomatosis from colorectal and appendiceal cancer. World J Surg. 1995;19(2):235–40.

    Article  CAS  PubMed  Google Scholar 

  2. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737–43.

    Article  PubMed  Google Scholar 

  3. Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004;5(4):219–28.

    Article  PubMed  Google Scholar 

  4. 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):3284–92.

    Article  CAS  PubMed  Google Scholar 

  5. Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.

    Article  PubMed  Google Scholar 

  6. Brucher BL, Piso P, Verwaal V, et al. Peritoneal carcinomatosis: cytoreductive surgery and HIPEC—overview and basics. Cancer Invest. 2012;30(3):209–24.

    Article  PubMed  Google Scholar 

  7. Bruin SC, Verwaal VJ, Vincent A, van’t Veer LJ, van Velthuysen ML. A clinicopathologic analysis of peritoneal metastases of colorectal and appendiceal origin. Ann Surg Oncol. 2010;17(9):2330–40.

    Article  PubMed  Google Scholar 

  8. Portilla AG, Shigeki K, Dario B, Marcello D. The intraoperative staging systems in the management of peritoneal surface malignancy. J Surg Oncol. 2008;98(4):228–31.

    Article  PubMed  Google Scholar 

  9. Levine EA, Stewart JH, Shen P, Russell GB, Loggie BL, Votanopoulos KI. Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients. J Am Coll Surg. 2014;218(4):573–85.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Esquivel J, Farinetti A, Sugarbaker PH. Elective surgery in recurrent colon cancer with peritoneal seeding: when to and when not to proceed. Il G Chir. 1999;20(3):81–6.

    CAS  Google Scholar 

  11. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  12. Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer. 2010;116(24):5608–18.

    Article  PubMed  Google Scholar 

  13. Kuijpers AM, Mirck B, Aalbers AG, et al. Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol. Ann Surg Oncol. 2013;20(13):4224–30.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Winer J, Zenati M, Ramalingam L, et al. Impact of aggressive histology and location of primary tumor on the efficacy of surgical therapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2014;21(5):1456–62.

  15. Franko J, Shi Q, Goldman CD, et al. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of north central cancer treatment group phase III trials N9741 and N9841. J Clin Oncol. 2012;30(3):263–7.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Van der Speeten K, Stuart OA, Sugarbaker PH. Pharmacokinetics and pharmacodynamics of perioperative cancer chemotherapy in peritoneal surface malignancy. Cancer J. 2009;15(3):216–24.

    Article  PubMed  Google Scholar 

  17. Park JS, Choi GS, Hasegawa S, et al. Validation of the seventh edition of the American Joint Committee on cancer tumor node-staging system in patients with colorectal carcinoma in comparison with sixth classification. J Surg Oncol. 2012;106(6):674–9.

    Article  PubMed  Google Scholar 

  18. Elias D, Gilly F, Boutitie F, 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(1):63–8.

    Article  PubMed  Google Scholar 

  19. El Halabi H, Gushchin V, Francis J, et al. Prognostic significance of lymph node metastases in patients with high-grade appendiceal cancer. Ann Surg Oncol. 2012;19(1):122–5.

    Article  Google Scholar 

  20. Kuijpers A, Mehta A, Boot H, et al. Perioperative systemic chemotherapy in peritoneal carcinomatosis of lymph node positive colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Oncol. 2014;25(4):864–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors thank the contributions of Debbie Soldano for her generous assistance and time with patient follow-up as well as our patients who have contributed to this study.

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA

    Joel M. Baumgartner MD, Kaitlyn J. Kelly MD & Andrew M. Lowy MD

  2. Clinical Trials Office, University of California San Diego Moores Cancer Center, La Jolla, CA, USA

    Laura Tobin MPH & Sean F. Heavey BS

  3. Department of Medicine, Division of Medical Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA

    Eric J. Roeland MD

Authors
  1. Joel M. Baumgartner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Tobin MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean F. Heavey BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaitlyn J. Kelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric J. Roeland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew M. Lowy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel M. Baumgartner MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baumgartner, J.M., Tobin, L., Heavey, S.F. et al. Predictors of Progression in High-Grade Appendiceal or Colorectal Peritoneal Carcinomatosis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 22, 1716–1721 (2015). https://doi.org/10.1245/s10434-014-3985-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3985-y

Keywords

Search

Navigation