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Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: prognosis and treatment of recurrences in a cohort study.
- Source :
-
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2012 Jun; Vol. 38 (6), pp. 509-15. Date of Electronic Publication: 2012 Apr 03. - Publication Year :
- 2012
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Abstract
- Background: Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) treatment of colorectal peritoneal carcinomatosis (PC) is gaining acceptance, but controversy remains. The primary aims were to analyse the outcome and prognostic variables of colorectal PC patients treated with CRS and IPC, and to report on the outcome of additional surgical treatments of subsequent recurrences.<br />Methods: Patients referred for treatment of colorectal PC between 1996 and 2010 were included in a cohort. The following data was collected: clinicopathological parameters, survival, recurrences, perioperative chemotherapy and type of IPC (hyperthermic intraperitoneal chemotherapy, HIPEC; or sequential postoperative intraperitoneal chemotherapy, SPIC). Multivariable analyses were conducted on potential prognostic factors for overall survival (OS).<br />Results: In the 151-patient cohort, the median OS was 34 months (range: 2-77) for CRS and HIPEC with five-year survival predicted at 40% (five-year disease-free survival 32%). For CRS and SPIC, the OS was 25 months (range: 2-188) with five-year survival at 18%. Open-and-close patients survived 6 months (range: 0-14) with no five-year survival (HIPEC vs. SPIC p = 0.047, SPIC vs. open-and-close p < 0.001). Adjuvant systemic chemotherapy was a noteworthy independent prognostic factor in the multivariable analysis. OS for patients undergoing additional surgical treatment of recurrences was 25 months vs. 10 months with best supportive care or palliative chemotherapy (p = 0.01).<br />Conclusion: Substantial long-term survival is possible in patients with colorectal PC. HIPEC was associated with better OS than SPIC and adjuvant systemic chemotherapy may improve the outcome in patients. Good OS is achievable in selected patients undergoing additional surgical treatment of isolated liver or peritoneal recurrences after prior complete CRS.<br /> (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Aged
Analysis of Variance
Carcinoma mortality
Carcinoma secondary
Chemotherapy, Adjuvant
Cohort Studies
Female
Humans
Hyperthermia, Induced
Kaplan-Meier Estimate
Male
Middle Aged
Peritoneal Neoplasms mortality
Peritoneal Neoplasms secondary
Prognosis
Proportional Hazards Models
Reoperation
Risk Assessment
Risk Factors
Treatment Outcome
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Carcinoma drug therapy
Carcinoma surgery
Chemotherapy, Cancer, Regional Perfusion methods
Colorectal Neoplasms pathology
Neoplasm Recurrence, Local surgery
Peritoneal Neoplasms drug therapy
Peritoneal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2157
- Volume :
- 38
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 22475555
- Full Text :
- https://doi.org/10.1016/j.ejso.2012.03.001