Abstract
Purpose
Recurrent disease following complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a relevant clinical scenario. We aimed to determine risk factors for recurrence.
Methods
Prospectively collected data of patients enrolled in the Peritoneal Surface Malignancy Program at the University of Tübingen between 2005 and 2011 were retrospectively analyzed. All patients were treated by standardized CRS and HIPEC. Recurrence was defined either radiographically by CT, PET-CT scan, or reoperation.
Results
Fifty-two patients received complete CRS (CC-0/CC-1) and HIPEC. Median time to recurrence was 229 days (103–1,028). Overall recurrence rate within follow-up was 48 %. Of patients with recurrent disease, 44 % experienced extraperitoneal systemic tumor spread. In multivariate analysis, grading of ≥3 was shown as an independent risk factor for recurrent disease, while a trend was observed for maximal tumor load in the upper abdominal region. Clinical parameters did not show an impact on recurrence.
Conclusions
Primary tumor grading seems to be an independent risk factor for recurrence following complete CRS and HIPEC in colorectal cancer-derived peritoneal surface malignancies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Glehen O, Gilly FN, Boutitie F, Bereder JM, Quenet F, Sideris L, Mansvelt B, Lorimier G, Msika S, Elias D (2010) Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer 116:5608–18
Yan TD, Morris DL (2008) Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg 248:829–835
Sugarbaker PH (1988) Surgical management of peritoneal carcinosis: diagnosis, prevention and treatment. Langenbecks Arch Chir 373:189–96
Sugarbaker PH (1995) Patient selection and treatment of peritoneal carcinomatosis from colorectal and appendiceal cancer. World J Surg 19:235–40
Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA (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 21:3737–43
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H (2008) Eight-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 15:2426–2432
Chua TC, Yan TD, Smigielski ME, Zhu KJ, Ng KM, Zhao J, Morris DL (2009) Long-term survival in patients with pseudomyxoma peritonei treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy: 10 years of experience from a single institution. Ann Surg Oncol 16:1903–11
Bijelic L, Yan TD, Sugarbaker PH (2007) Failure analysis of recurrent disease following complete cytoreduction and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Ann Surg Oncol 14:2281–8
Verwaal VJ, Boot H, Aleman BM, van Tinteren H, Zoetmulder FA (2004) Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome. Ann Surg Oncol 11:375–9
Elias D, Goéré D, Di Pietrantonio D, Boige V, Malka D, Kohneh-Shahri N, Dromain C, Ducreux M (2008) Results of systematic second-look surgery in patients at high risk of developing colorectal peritoneal carcinomatosis. Ann Surg 247:445–50
Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42
Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–74
Pelz JO, Stojadinovic A, Nissan A, Hohenberger W, Esquivel J (2009) Evaluation of a peritoneal surface disease severity score in patients with colon cancer with peritoneal carcinomatosis. J Surg Oncol 99:9–15
Kraemer M, Wiratkapun MD, Seow-Choen F, Ho YH, Eu KW, Nyam D (2001) Stratifying risk factors for follow-up: a comparison of recurrent and nonrecurrent colorectal cancer. Dis Colon Rectum 44:815–821
Thomson WH, Foy CJ, Longman RJ (2008) The nature of local recurrence after colorectal cancer recurrence. Color Dis 10:69–74
Günther K, Dworak O, Remke S et al (2002) Prediction of distant metastases after curative surgery for rectal cancer. J Surg Res 103:68–78
Cusack JC, Giacco GG, Cleary K, Davidson BS, Izzo F, Skibber J, Yen J, Curley SA (1996) Survival factors in 186 patients younger than 40 years old with colorectal adenocarcinoma. J Am Coll Surg 183:105–12
Nissan A, Guillem JG, Paty PB, Wong WD, Cohen AM (1999) Signet-ring cell carcinoma of the colon and rectum: a matched control study. Dis Colon Rectum 42:1176–80
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
This manuscript contains original material that has not been previously published.
Rights and permissions
About this article
Cite this article
Königsrainer, I., Horvath, P., Struller, F. et al. Risk factors for recurrence following complete cytoreductive surgery and HIPEC in colorectal cancer-derived peritoneal surface malignancies. Langenbecks Arch Surg 398, 745–749 (2013). https://doi.org/10.1007/s00423-013-1065-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-013-1065-6