Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of Early Postoperative Intraperitoneal Chemotherapy After Complete Surgical Resection of Peritoneal Metastasis from Colorectal Cancer: A Case–Control Study from a Single Center

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

Abstract

Background

Early postoperative intraperitoneal chemotherapy (EPIC) is a type of intraperitoneal chemotherapy for patients with colorectal cancer and peritoneal metastasis. However, there is a paucity of clinical studies evaluating the efficacy of EPIC after complete cytoreductive surgery. This study was designed to evaluate the efficacy of EPIC in patients who underwent complete surgical resection of peritoneal metastasis from colorectal cancer.

Methods

A 1:2 matched case–control study was conducted in patients undergoing complete surgical resection of peritoneal metastases from colorectal cancer at our institution between January 2000 and November 2013. The operative and survival outcomes of patients receiving EPIC (EPIC group) and those who did not (no EPIC group) were compared.

Results

Thirty patients who were treated with EPIC were matched with 15 patients who did not receive EPIC. The 3-year overall survival (OS) and disease-free survival (DFS) were 74.3 and 53.0 % in the EPIC group and 34.7 and 7.5 % in the no EPIC group (EPIC group vs. no EPIC group: OS, P = 0.016; DFS, P = 0.002). Multivariate analysis identified EPIC and adjuvant systemic chemotherapy as independent prognostic factors for OS, whereas only EPIC was prognostic factor for DFS. For peritoneal-DFS, EPIC was the only significant variable in the univariate analysis (hazard ratio, 2.70; 95 % confidence interval 1.17–6.21; P = 0.020).

Conclusions

EPIC is a safe and efficacious option for intraperitoneal chemotherapy to prevent peritoneal recurrence and prolong survival after complete resection of peritoneal metastasis from colorectal cancer.

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
Fig. 2

Similar content being viewed by others

References

  1. Knorr C, Reingruber B, Meyer T, Hohenberger W, Stremmel C. Peritoneal carcinomatosis of colorectal cancer: incidence, prognosis, and treatment modalities. Int J Colorectal Dis. 2004;19:181–7.

    Article  CAS  PubMed  Google Scholar 

  2. Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89:1545–50.

    Article  CAS  PubMed  Google Scholar 

  3. Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355:1041–7.

    Article  CAS  PubMed  Google Scholar 

  4. Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.

    Article  CAS  PubMed  Google Scholar 

  5. Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-Year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.

    Article  PubMed  Google Scholar 

  6. Cao C, Yan TD, Black D, Morris DL. A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2009;16:2152–65.

    Article  PubMed  Google Scholar 

  7. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;1027:681–5.

    Article  Google Scholar 

  8. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. National Cancer Institute: Common terminology criteria for adverse events version 4.0. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm.

  10. 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;22:3284–92.

    Article  CAS  PubMed  Google Scholar 

  11. 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;28:63–8.

    Article  PubMed  Google Scholar 

  12. Mulsow J, Merkel S, Agaimy A, Hohenberger W. Outcomes following surgery for colorectal cancer with synchronous peritoneal metastases. Br J Surg. 2011;98:1785–91.

    Article  CAS  PubMed  Google Scholar 

  13. Matsuda K, Hotta T, Takifuji K, et al. Clinical impact of a macroscopically complete resection of colorectal cancer with peritoneal carcinomatosis. Surgery. 2012;151:238–44.

    Article  PubMed  Google Scholar 

  14. 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;39:321–7.

    Article  PubMed  Google Scholar 

  15. Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004;11:518–21.

    Article  PubMed  Google Scholar 

  16. Cashin PH, Graf W, Nygren P, Mahteme H. Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: prognosis and treatment of recurrences in a cohort study. Eur J Surg Oncol. 2012;38:509–15.

    Article  CAS  PubMed  Google Scholar 

  17. Kuijpers AM, Mehta AM, Boot H, van Leerdam ME, Hauptmann M, Aalbers AG, Verwaal VJ. Perioperative systemic chemotherapy in peritoneal carcinomatosis of lymph node positive colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Oncol. 2014;25:864–9.

    Article  CAS  PubMed  Google Scholar 

  18. Verwaal VJ, Boot H, Aleman BM, van Tinteren H, Zoetmulder FA. Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome. Ann Surg Oncol. 2004;11:375–9.

    Article  PubMed  Google Scholar 

  19. Elias D, Benizri E, Di Pietrantonio D, Menegon P, Malka D, Raynard B. Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2007;14:509–14.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.

    Article  CAS  PubMed  Google Scholar 

  22. Chua TC, Esquivel J, Pelz JO, Morris DL. Summary of current therapeutic options for peritoneal metastases from colorectal cancer. J Surg Oncol. 2013;107:566–73.

    Article  PubMed  Google Scholar 

  23. Klaver YL, Hendriks T, Lomme RM, Rutten HJ, Bleichrodt RP, de Hingh IH. Hyperthermia and intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis: an experimental study. Ann Surg. 2011;254:125–130.

    Article  PubMed  Google Scholar 

  24. Klaver YL, Hendriks T, Lomme RM, Rutten HJ, Bleichrodt RP, de Hingh IH. Intraoperative versus early postoperative intraperitoneal chemotherapy after cytoreduction for colorectal peritoneal carcinomatosis: an experimental study. Ann Surg Oncol. 2012;19 Suppl 3:S475–82.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by Kyungpook National University Research Fund, 2012.

Disclosures

Drs. Soo Yeun Park, Gyu-Seog Choi, Jun Seok Park, Hye Jin Kim, Jong Ik Choi, Chun-Seok Yang, Jong Gwang Kim, Byung Woog Kang have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea

    Soo Yeun Park MD, Gyu-Seog Choi MD, PhD, Jun Seok Park MD, PhD , Hye Jin Kim MD & Chun-Seok Yang MD

  2. Department of Hematology/Oncology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea

    Jong Gwang Kim MD, PhD  & Byung Woog Kang MD, PhD

Authors
  1. Soo Yeun Park MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gyu-Seog Choi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Seok Park MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hye Jin Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chun-Seok Yang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jong Gwang Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Byung Woog Kang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gyu-Seog Choi MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, S.Y., Choi, GS., Park, J.S. et al. Efficacy of Early Postoperative Intraperitoneal Chemotherapy After Complete Surgical Resection of Peritoneal Metastasis from Colorectal Cancer: A Case–Control Study from a Single Center. Ann Surg Oncol 23, 2266–2273 (2016). https://doi.org/10.1245/s10434-016-5148-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5148-9

Keywords

Search

Navigation