Skip to main content
SpringerLink
Log in

Long-Term Outcomes After R0 Resection of Synchronous Peritoneal Metastasis from Colorectal Cancer Without Cytoreductive Surgery or Hyperthermic Intraperitoneal Chemotherapy

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

Abstract

Background

The National Comprehensive Cancer Network (NCCN) guidelines for colon cancer recently added the following footnote regarding the therapeutic strategy for peritoneal metastases: “If R0 resection can be achieved, surgical resection of isolated peritoneal disease may be considered at experienced centers.” This study investigated the efficacy of R0 resection of peritoneal metastasis from colorectal cancer without cytoreductive surgery or hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

This retrospective cohort study was conducted at a single-institution tertiary care cancer center. Among 496 consecutive M1c colorectal cancer patients, R0 resection was achieved for 94 patients (19%). The subjects were 78 consecutive patients with colorectal cancer and simultaneous peritoneal metastasis but no other distant metastases who underwent R0 resection at the National Cancer Center Hospital from 1971 to 2016 (16% of all M1c patients). Overall survival (OS) was investigated, and clinicopathologic variables were analyzed for prognostic significance.

Results

No perioperative mortality was noted. The 3-year OS rate was 45%, and the 5-year OS rate was 28.7%. The median survival time was 33.4 months. Notably, 17 patients survived for more than 5 years, and 9 of these patients did not receive any chemotherapy. Multivariate analysis showed cancer location in the colon and harvesting of 12 or more lymph nodes to be independent factors associated with a better prognosis.

Conclusions

From the perspective of long-term outcomes and no perioperative mortality, R0 resection of peritoneal metastasis from colorectal cancer, without complete peritonectomy or HIPEC, appeared to be an acceptable therapeutic option for some patients with peritoneal metastasis.

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. Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2017. doi:10.1007/s10147-017-1101-6.

    Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. UICC. TNM Classification of Malignant Tumours, 8th ed. Wiley: New York; 2017.

  4. 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:e362–9.

    Article  PubMed  Google Scholar 

  5. Benson AB III, Venook AP, Cederquist L, et al. Colon Cancer, version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15:370–98.

    Article  PubMed  Google Scholar 

  6. Rectum JSfCotCa. Japanese Classification of Colorectal Carcinoma (8th ed). Kanehara & Co., Ltd: Tokyo, 2013.

  7. Kobayashi H, Kotake K, Sugihara K; Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the C, Rectum. Enhancing the objectivity of the Japanese classification of peritoneal metastases from colorectal cancer. Jpn J Clin Oncol. 2014;44:898–902.

    Article  PubMed  Google Scholar 

  8. 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 

  9. Ihemelandu C, Sugarbaker PH. Management for peritoneal metastasis of colonic origin: role of cytoreductive surgery and perioperative intraperitoneal chemotherapy: a single institution’s experience during two decades. Ann Surg Oncol. 2017;244:898–905.

    Article  Google Scholar 

  10. Elias D, Glehen O, Pocard M, et al. A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg. 2010;251:896–901.

    Article  PubMed  Google Scholar 

  11. Morris EJ, Forman D, Thomas JD, et al. Surgical management and outcomes of colorectal cancer liver metastases. Br J Surg. 2010;97:1110–18.

    Article  CAS  PubMed  Google Scholar 

  12. Jones RP, Kokudo N, Folprecht G, et al. Colorectal liver metastases: a critical review of state of the art. Liver Cancer. 2016;6:66–71.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Noura S, Ohue M, Ito Y, et al. New staging system for colorectal cancer patients with synchronous peritoneal metastasis in accordance with the Japanese classification of colorectal carcinoma: a multi-institutional study. Dig Surg. 2016;33:66–73.

    Article  PubMed  Google Scholar 

  14. Kobayashi H, Kotake K, Sugihara K. Outcomes of surgery without HIPEC for synchronous peritoneal metastasis from colorectal cancer: data from a multi-center registry. Int J Clin Oncol. 2014;19:98–105.

    Article  PubMed  Google Scholar 

  15. Sato H, Maeda K, Kotake K, Sugihara K, Takahashi H. Factors affecting recurrence and prognosis after R0 resection for colorectal cancer with peritoneal metastasis. J Gastroenterol. 2016;51:465–72.

    Article  CAS  PubMed  Google Scholar 

  16. Ozawa H, Kotake K, Kobayashi H, Kobayashi H, Sugihara K. Prognostic factors for peritoneal carcinomatosis originating from colorectal cancer: an analysis of 921 patients from a multi-institutional database. Surg Today. 2014;44:1643–50.

    Article  PubMed  Google Scholar 

  17. Kobayashi H, Kotake K, Funahashi K, et al. Clinical benefit of surgery for stage IV colorectal cancer with synchronous peritoneal metastasis. J Gastroenterol. 2014;49:646–54.

    Article  PubMed  Google Scholar 

  18. Furuhata T, Okita K, Nishidate T, et al. Oncological benefit of primary tumor resection with high tie lymph node dissection in unresectable colorectal cancer with synchronous peritoneal metastasis: a propensity score analysis of data from a multi-institute database. Int J Clin Oncol. 2015;20:922–7.

    Article  PubMed  Google Scholar 

Download references

Disclosures

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan

    Dai Shida MD, PhD, Shunsuke Tsukamoto MD, PhD, Hiroki Ochiai MD, PhD & Yukihide Kanemitsu MD

Authors
  1. Dai Shida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shunsuke Tsukamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroki Ochiai MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukihide Kanemitsu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dai Shida MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shida, D., Tsukamoto, S., Ochiai, H. et al. Long-Term Outcomes After R0 Resection of Synchronous Peritoneal Metastasis from Colorectal Cancer Without Cytoreductive Surgery or Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 25, 173–178 (2018). https://doi.org/10.1245/s10434-017-6133-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-6133-7

Keywords

Search

Navigation