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Multimodality treatment of peritoneal carcinomatosis from colorectal cancer: first results of a new German centre for peritoneal surface malignancies

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The presence of peritoneal carcinomatosis arising from colorectal cancer is associated with a poor prognosis. It was the purpose of this study to analyze morbidity, mortality, and survival after major cytoreductive surgery and intraperitoneal chemotherapy.

Materials and methods

Thirty-two patients with peritoneal carcinomatosis were operated between April 2004 and June 2006 with the aim of complete macroscopical cytoreduction. All had a primary colorectal carcinoma. Surgery in these patients was followed by hyperthermic intraperitoneal chemotherapy (HIPEC) consisting of mitomycin C and doxorubicin. Data were analyzed retrospectively.

Results

Of all patients, 16 had appendix and 16 non-appendiceal colorectal carcinoma. A macroscopically complete cytoreduction was achieved in 24 patients by parietal and visceral peritonectomy procedures. All resections were combined with HIPEC. Overall morbidity was 34%. Most frequent surgical complications were intestinal obstruction (4/32), enteric fistula (2/32), pancreatitis (2/32), and bile leakage (2/32). One patient presented grade 4 renal toxicity. There was no hospital mortality. The median follow-up was 12 months. The 1-year overall survival rate is 96%. All patients after complete cytoreduction are still alive.

Conclusions

Cytoreductive surgery combined with HIPEC is associated with an acceptable morbidity and low mortality. Complete cytoreduction may improve survival, particularly in well-selected patients having a low tumor volume and no extra-abdominal metastases.

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References

  1. Minsky BD, Mies C, Rich TA, Recht A, Chaffey JT (1988) Potentially curative surgery of colon cancer: patterns of failure and survival. J Clin Oncol 6:106–118

    Article  CAS  PubMed  Google Scholar 

  2. Chu DZD, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy. Cancer 63:364–367

    Article  CAS  PubMed  Google Scholar 

  3. Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363

    Article  CAS  PubMed  Google Scholar 

  4. Folprecht G, Lutz MP, Schoffski P et al (2006) Cetuximab and irinotecan/5-fluorouracil is a safe combination for the first line treatment of patients with epidermal growth factor receptor expressing metastatic colorectal carcinoma. Ann Oncol 17:450–456

    Article  CAS  PubMed  Google Scholar 

  5. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sugarbaker PH (2003) Carcinomatosis—is cure an option? J Clin Oncol 5:762–764

    Article  Google Scholar 

  7. Verwaal V, van Ruth S, de Bree E et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21:3737–3743

    Article  PubMed  Google Scholar 

  8. Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22:3284–3292

    Article  CAS  PubMed  Google Scholar 

  9. Sugarbaker PH, Jablonski KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221:124–1323

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sugarbaker PH, Chang D (1999) Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 6(8):727–731

    Article  CAS  PubMed  Google Scholar 

  11. Verwaal V, van Ruth S, Witkamp A et al (2005) Long-term survival of peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol 12(1):65–71

    Article  PubMed  Google Scholar 

  12. Glehen O, Mithieux F, Osinsky D et al (2003) Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 21:799–806

    Article  CAS  PubMed  Google Scholar 

  13. Elias D, Antoun S, Goharin A et al (2000) Research on the best chemohyperthermia technique of treatment of peritoneal carcinomatosis after complete resection Int J Surg Investig 1:431–439

    CAS  PubMed  Google Scholar 

  14. Elias D, Matsuhisa T, Sideris L et al (2004) Heated intra-operative intraperitoneal oxaliplatin plus irinotecan after complete resection of peritoneal carcinomatosis: pharmacokinetics, tissue distribution and tolerance. Ann Oncol 15:1558–1565

    Article  CAS  PubMed  Google Scholar 

  15. Gonzalez Bayon L, Gonzalez Moreno S, Ortega Perez G (2006) Safety considerations for operating room personnel during hyperthermic intraperitoneal chemotherapy perfusion. Eur J Surg Oncol 6:619–625

    Article  Google Scholar 

  16. Sugarbaker PH, Mora JT, Carmignani P et al (2005) Update on chemotherapeutic agents utilized for perioperative intraperitoneal chemotherapy. Oncologist 10:112–122

    Article  CAS  PubMed  Google Scholar 

  17. Sugarbaker PH, Stuart OA, Carmignani PC (2006) Pharmacokinetic changes induced by the volume of chemotherapy solution in patients treated with hyperthermic intraperitoneal mitomycin C. Cancer Chemother Pharmacol 57:703–708

    Article  CAS  PubMed  Google Scholar 

  18. Stephens AD, Aldermann R, Chang D et al (2000) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative chemotherapy using the Coliseum technique. Ann Surg Oncol 6:790–796

    Article  Google Scholar 

  19. Schmidt U, Dahlke MH, Klempnauer J et al (2005) Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 31:53–58

    Article  CAS  PubMed  Google Scholar 

  20. Glehen O, Osinksy D, Cotte E et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10:853–869

    Article  Google Scholar 

  21. Piso P, Bektas H, Werener U et al (2001) Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 27:286–290

    Article  CAS  PubMed  Google Scholar 

  22. Witkamp AJ, de Bree E, Kaag MM et al (2001) Extensive cytoreductive surgery followed by intraoperative hyperthermic intraperitoneal chemotherapy with mitomycin C in patients with peritoneal carcinomatosis of colorectal origin. Eur J Cancer 37:979–984

    Article  CAS  PubMed  Google Scholar 

  23. Elias D, Blot F, El Otmany A et al (2001) Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 92:71–76

    Article  CAS  PubMed  Google Scholar 

  24. Pilati P, Mocellin S, Rossi CR et al (2003) Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma. Ann Surg Oncol 10:508–513

    Article  PubMed  Google Scholar 

  25. Glehen O, Cotte E, Schreiber V et al (2004) Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg 91:747–754

    Article  CAS  PubMed  Google Scholar 

  26. Shen P, Hawksworth J, Lovato J et al (2004) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 11:178–186

    Article  PubMed  Google Scholar 

  27. Kekmanovic DM, Pavlov MJ, Ceranic MS et al (2005) Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg 31:147–152

    Article  Google Scholar 

  28. McQuellon, Loggie BW, Lehman AB et al (2003) Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol 10:155–162

    Article  PubMed  Google Scholar 

  29. Koppe MJ, Boerman OC, Oyen WJG et al (2006) Peritoneal carcinomatosis of colorectal cancer—incidence and current treatment strategies. Ann Surg 243:212–222

    Article  PubMed  PubMed Central  Google Scholar 

  30. Moran BJ, Meade B, Murphy E (2006) Hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for peritoneal carcinomatosis of colorectal origin: a novel treatment strategy with promising results in selected patients. Colorect Dis 8:544–550

    Article  CAS  Google Scholar 

  31. Matheme H, Hannsson J, Berglund A, Pahlman L, Glimelius B, Nygren P, Graf W (2004) Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study. Br J Cancer 90:403–407

    Article  Google Scholar 

  32. Jaquet P, Sugarbaker PH (1996) Clinical research methodologies on diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374

    Article  Google Scholar 

  33. Esquivel J, Sticca R, Sugarbaker PH et al (2007) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol 14:128–133

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Regensburg, Regensburg, Germany

    P. Piso, M. H. Dahlke, N. Ghali, I. Iesalnieks, M. Loss, F. Popp, P. von Breitenbuch, A. Agha, S. A. Lang & H. J. Schlitt

  2. Department of Internal Medicine I, University of Regensburg, Regensburg, Germany

    F. Kullmann

  3. Klinik und Poliklinik für Chirurgie, Klinikum der Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    P. Piso

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  1. P. Piso
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  2. M. H. Dahlke
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  4. I. Iesalnieks
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Correspondence to P. Piso.

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Piso, P., Dahlke, M.H., Ghali, N. et al. Multimodality treatment of peritoneal carcinomatosis from colorectal cancer: first results of a new German centre for peritoneal surface malignancies. Int J Colorectal Dis 22, 1295–1300 (2007). https://doi.org/10.1007/s00384-007-0313-z

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  • DOI: https://doi.org/10.1007/s00384-007-0313-z

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