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Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Selection of colorectal cancer patients with concomitant peritoneal (PM) and liver metastases (LM) for radical treatment with cytoreductive surgery (CRS), including liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), needs improvement. This retrospective, monocentric study was designed to evaluate the predictive factors for early recurrence, disease-free survival (DFS), and overall survival (OS) in such patients treated in a referral center.

Methods

Consecutive colorectal cancer patients with concomitant LM and PM treated with curative intent with perioperative systemic chemotherapy, simultaneous complete CRS, liver resection, and HIPEC in 2011–2022 were included. Clinical, radiological (before and after preoperative chemotherapy), surgical, and pathological data were investigated, along with long-term oncologic outcomes. A multivariate analysis was performed to identify predictive factors associated with early recurrence (diagnosed <6 months after surgery), DFS, and OS.

Results

Of more than 61 patients included, 31 (47.1%) had pT4 and 27 (40.9%) had pN2 primary tumors. Before preoperative chemotherapy, the median number of LM was 2 (1–4). The median surgical PCI (peritoneal carcinomatosis index) was 3 (5–8.5). The median DFS and OS were 8.15 (95% confidence interval [CI] 5.5–10.1) and 34.1 months (95% CI 28.1–53.5), respectively. In multivariate analysis, pT4 (odds ratio [OR] = 4.14 [1.2–16.78], p = 0.032]) and pN2 (OR = 3.7 [1.08–13.86], p = 0.042) status were independently associated with an early recurrence, whereas retroperitoneal lymph node metastasis (hazard ratio [HR] = 39 [8.67–175.44], p < 0.001) was independently associated with poor OS.

Conclusions

In colorectal cancer patients with concomitant PM and LM, an advanced primary tumor (pT4 and/or pN2) was associated with a higher risk of early recurrence following a radical multimodal treatment, whereas RLN metastases was strongly detrimental for OS.

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France

    Rémi Grange MD

  2. Department of Radiology, CHU Lyon Sud, Hospices Civils de Lyon, CICLY EMR 3738, Lyon 1 University, Pierre Bénite, France

    Pascal Rousset MD, PhD

  3. Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France

    Nicolas Williet MD, PhD & Jean-Marc Phelip MD, PhD

  4. Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France

    Mathias Guesnon MD, Guillaume Passot MD, PhD, Olivier Glehen MD, PhD & Vahan Kepenekian MD, PhD

  5. CICLY, EMR 3738, Lyon 1 University, Lyon, France

    Mathias Guesnon MD, Guillaume Passot MD, PhD, Olivier Glehen MD, PhD & Vahan Kepenekian MD, PhD

  6. Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France

    Laurent Milot MD, PhD & Bertrand Le Roy MD, PhD

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Supplemental Fig. 1

A 69-year-old female was referred for synchronous PM and LM from sigmoid pT4N2 adenocarcinoma. Initial CT scan at portal phase revealed 9 LM, the largest of which measured 35 mm (arrow) (A). Initial PCI score was 4, including a 10-mm peritoneal nodule of the left pre-renal fascia (dotted arrow) (B). Preoperative CT scan after 12 cycles of Folfirinox-Cetuximab showed a significant reduction in size of the nine LM (partial response according RECIST 1.1 classification), the largest measuring 25 mm with necrotic modification (arrow) (C). Peritoneal analysis assessed the PCI score at 3, with reduction in size of the nodule, and a thickening of the left pre-renal fascia (dotted arrow) (D). PCI score was assessed at 5 intraoperatively. The patient had a complete resection of the PM (completeness of cytoreduction score at 0) with four hepatic wedge resections combined with five radiofrequency ablations. The patient had a postoperative ileus. The patient presented an early recurrence at 2 months, treated with chemotherapy. The patient was still alive 14 months after surgery (JPG 69 KB)

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Grange, R., Rousset, P., Williet, N. et al. Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence. Ann Surg Oncol 31, 2378–2390 (2024). https://doi.org/10.1245/s10434-023-14840-2

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