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Primary Tumor Location and Outcomes After Cytoreductive Surgery and Intraperitoneal Chemotherapy for Peritoneal Metastases of Colorectal Origin

A Correction to this article was published on 01 October 2020

This article has been updated



The aim of this study is to evaluate outcomes in patients with peritoneal metastasis of colorectal cancer (pmCRC) who underwent cytoreductive surgery and intraperitoneal chemotherapy (CRS/IPC) in relation to the location of the primary tumor. Regional therapy, including cytoreductive surgery and intraperitoneal chemotherapy, has been associated with improved survival in patients with pmCRC. Location of the primary tumor has been shown to be prognostic in patients with metastasis.

Patients and Methods

A retrospective review was performed for all patients who underwent complete cytoreduction and intraperitoneal chemotherapy from 2010 to 2017, examining patient and tumor characteristics, overall and recurrence-free survival, recurrence patterns, and tumor mutational profiles.


Ninety-three patients were included in the study: 49 (53%) with a right-sided and 44 (47%) with a left-sided primary tumor. Patients with a right-sided tumor had significantly shorter recurrence-free survival (median, 6.3 months; 95% CI, 4.7–8.1 months vs 12.3 months; 95% CI, 3.6–21.7 months; P = 0.02) and overall survival (median, 36.6 months; 95% CI, 26.4–46.9 months vs 83.3 months; 95% CI 44.2–122.4 months; P = 0.03). BRAF and KRAS mutations were more frequent in right-sided tumors, and APC and TP53 mutations were more frequent in left-sided tumors, which were more chromosomally instable. BRAF mutations were associated with early recurrence.


Tumor sidedness is a predictor of oncological outcomes after CRS/IPC. Tumor sidedness and molecular characteristics should be considered when counseling patients regarding expected outcomes and when selecting or stratifying pmCRC patients for clinical trials of regional therapy.

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This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Jonathan B. Yuval was supported in part by the NCI Grant T32 CA009501. We thank Arthur Gelmis, BS, Department of Surgery, Memorial Sloan Kettering Cancer Center, for editing the manuscript.

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Correspondence to Garrett M. Nash MD, MPH.

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Dr. Yaeger has received research funding from Array BioPharma, Genentech, GlaxoSmithKline, and Novartis and has served as an advisory board member for GlaxoSmithKline. Dr. Garcia-Aguilar has received fees from Medtronic, Johnson and Johnson, and Intuitive Surgical. Dr. Cercek is an employee/paid consultant for Bayer and Proteus and reports receiving commercial research grants from Seattle Genetics. Dr. Nash has received meal reimbursement from Intuitive Surgical.

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Supplementary Fig. 1

Overall survival. In relation to synchronous/metachronous pmCRC diagnosis (A) and to PCI (B). CRS/IPC cytoreductive surgery with intraperitoneal chemotherapy, PCI peritoneal cancer index (PDF 938 kb)

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Adileh, M., Yuval, J.B., Walch, H.S. et al. Primary Tumor Location and Outcomes After Cytoreductive Surgery and Intraperitoneal Chemotherapy for Peritoneal Metastases of Colorectal Origin. Ann Surg Oncol 28, 1109–1117 (2021).

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