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Primary Tumor Sidedness is Predictive of Survival in Colon Cancer Patients Treated with Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy: A US HIPEC Collaborative Study

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

Abstract

Introduction

The clinical relevance of primary tumor sidedness is not fully understood in colon cancer patients with peritoneal metastasis treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

This was a retrospective cohort study of a multi-institutional database of patients with peritoneal surface malignancy at 12 participating high-volume academic centers from the US HIPEC Collaborative.

Results

Overall, 336 patients with colon primary tumors who underwent curative-intent CRS with or without HIPEC were identified; 179 (53.3%) patients had right-sided primary tumors and 157 (46.7%) had left-sided primary tumors. Patients with right-sided tumors were more likely to be older, male, have higher Peritoneal Cancer Index (PCI), and have a perforated primary tumor, but were less likely to have extraperitoneal disease. Patients with complete cytoreduction (CC-0/1) had a median disease-free survival (DFS) of 11.5 months (95% confidence interval [CI] 7.6–15.3) versus 13.1 months (95% CI 9.5–16.8) [p = 0.158] and median overall survival (OS) of 30 months (95% CI 23.5–36.6) versus 45.4 months (95% CI 35.9–54.8) [p = 0.028] for right- and left-sided tumors; respectively. Multivariate analysis revealed that right-sided primary tumor was an independent predictor of worse DFS (hazard ratio [HR] 1.75, 95% CI 1.19–2.56; p =0.004) and OS (HR 1.72, 95% CI 1.09–2.73; p = 0.020).

Conclusion

Right-sided primary tumor was an independent predictor of worse DFS and OS. Relevant clinicopathologic criteria, such as tumor sidedness and PCI, should be considered in patient selection for CRS with or without HIPEC, and guide stratification for clinical trials.

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Authors and Affiliations

  1. Department of Surgery, University of California, San Diego, San Diego, CA, USA

    Nikhil V. Kotha, Joel M. Baumgartner MD, MAS, Jula Veerapong MD, Andrew M. Lowy MD & Kaitlyn J. Kelly MD

  2. Department of Surgery, Ohio State University, Columbus, OH, USA

    Jordan M. Cloyd MD & Ahmed Ahmed MD

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Travis E. Grotz MD & Jennifer L. Leiting MD

  4. Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier MD & Andrew J. Lee MD

  5. Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Sean P. Dineen MD & Sophie Dessureault MD, PhD

  6. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia Clarke MD & Harveshp Mogal MD

  7. Department of Surgery, Emory University, Atlanta, GA, USA

    Mohammad Y. Zaidi MD & Maria C. Russell

  8. Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA

    Sameer H. Patel MD, Jeffrey J. Sussman MD & Vikrom Dhar MD

  9. Department of Surgery, Huntsman Cancer Institute, Salt Lake City, UT, USA

    Laura A. Lambert MD

  10. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Ryan J. Hendrix MD

  11. Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Daniel E. Abbott MD & Courtney Pokrzywa MD

  12. Department of Surgery, City of Hope Cancer Center, Duarte, CA, USA

    Kelly Lafaro MD & Byrne Lee MD

  13. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Jonathan B. Greer MD & Nadege Fackche MD

Authors
  1. Nikhil V. Kotha
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  2. Joel M. Baumgartner MD, MAS
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  3. Jula Veerapong MD
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  4. Jordan M. Cloyd MD
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  5. Ahmed Ahmed MD
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  6. Travis E. Grotz MD
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  7. Jennifer L. Leiting MD
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  8. Keith Fournier MD
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  9. Andrew J. Lee MD
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  10. Sean P. Dineen MD
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  11. Sophie Dessureault MD, PhD
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  12. Callisia Clarke MD
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  13. Harveshp Mogal MD
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  14. Mohammad Y. Zaidi MD
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  15. Maria C. Russell
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  16. Sameer H. Patel MD
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  17. Jeffrey J. Sussman MD
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  18. Vikrom Dhar MD
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  19. Laura A. Lambert MD
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  20. Ryan J. Hendrix MD
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  21. Daniel E. Abbott MD
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  22. Courtney Pokrzywa MD
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  23. Kelly Lafaro MD
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  24. Byrne Lee MD
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  25. Jonathan B. Greer MD
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  26. Nadege Fackche MD
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  27. Andrew M. Lowy MD
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  28. Kaitlyn J. Kelly MD
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Corresponding author

Correspondence to Kaitlyn J. Kelly MD.

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Kotha, N.V., Baumgartner, J.M., Veerapong, J. et al. Primary Tumor Sidedness is Predictive of Survival in Colon Cancer Patients Treated with Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy: A US HIPEC Collaborative Study. Ann Surg Oncol 26, 2234–2240 (2019). https://doi.org/10.1245/s10434-019-07373-0

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  • DOI: https://doi.org/10.1245/s10434-019-07373-0

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