Ann Surg Treat Res.  2016 Oct;91(4):157-164. 10.4174/astr.2016.91.4.157.

Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal cancer: 2-year follow-up results at a single institution in Korea

• Jo MH
• Suh JW
• Yun JS
• Namgung H
• Park DG

• KMID: 2354322
• DOI: http://doi.org/10.4174/astr.2016.91.4.157

Abstract

PURPOSE
The purpose of this study was to examine 2-year follow-up results of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis (PC) of colorectal cancer.
METHODS
We performed 54 cases of CRS and IPC in 53 patients with PC of colorectal cancer from December 2011 to December 2013. We collected data prospectively and analyzed the grade of PC, morbidity and mortality, and short-term follow-up (median, 10 months; range, 2-47 months) results.
RESULTS
Mean peritoneal cancer index (PCI) was 15 (range, 1-35), and complete cytoreduction was possible in 35 patients (64.8%). Complications occurred in 25 patients (46.3%) and mortality occurred in 4 patients (7.4%). Excluding the 4 mortalities, 17 patients out of 49 patients (31.5%) were alive at the time of the last follow-up and the overall median survival was 10.3 months. Patients with complete cytoreduction had a median survival of 22.6 months, which was significantly longer than the median survival of 3.5 months for patients without complete cytoreduction (P < 0.001). PCI grade, CCR grade, cell type, and postoperative chemotherapy were significant prognostic factors by univariate analysis. Positive independent prognostic factors by multivariate analysis included PCI grade and postoperative chemotherapy.
CONCLUSION
CRS and IPC increased the survival of patients with low PCI and postoperative systemic chemotherapy was mandatory. However, this combined therapeutic approach showed high rate of complications and mortality. Therefore, this aggressive treatment should be performed in only selected patients by considering the general condition of the patient and the extent of PC.

Keyword

Colorectal neoplasms; Peritoneal carcinomatosis; Cytoreductive surgery; Intraperitoneal chemotherapy

MeSH Terms

Carcinoma*
Colorectal Neoplasms*
Drug Therapy*
Follow-Up Studies*
Humans
Korea*
Mortality
Multivariate Analysis
Prospective Studies

Figure

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  Fig. 1 Operative findings of cytoreductive surgery for peritoneal carcinomatosis from sigmoid colon cancer: (A) right upper quadrant peritonectomy with cholecystectomy, (B) left upper quadrant peritonectomy with splenectomy, (C) pelvic peritonectomy with low anterior resection, total abdominal hysterectomy, and bilateral salpingoophorectomy, and (D) operation specimen.

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  Fig. 2 Hperthermic intraperitoneal chemotherapy using the Belmont Hyperthermic Pump (Belmont Instrument Corp., Billerica, MA, USA).

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  Fig. 3 Overall survival for 49 patients after cytoreductive surgery and intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal cancer.

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  Fig. 4 Overall survival according to completeness of cytoreduction. Complete cytoreduction group (CCR 0–1) had a better survival than incomplete cytoreduction group (CCR 2–3) (median survival: 22.6 months vs. 3.5 months, P < 0.001).

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