D Elias1, A Mariani2, A-S Cloutier2, F Blot3, D Goéré2, F Dumont2, C Honoré2, V Billard4, P Dartigues5, M Ducreux6. 1. Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France. Electronic address: dominique.elias@gustaveroussy.fr. 2. Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France. 3. Intensive Care Unit, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France. 4. Department of Anesthesiology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France. 5. Department of Pathology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France. 6. Department of Medical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
Abstract
BACKGROUND: Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is on the verge of becoming the gold standard treatment for selected patients presenting peritoneal metastases (PM) of colorectal origin. PM is scored with the peritoneal cancer index (PCI), which is the main prognostic factor. However, small bowel (SB) involvement could exert an independent prognostic impact. AIM: To define an adequate cut-off for the PCI and to appraise whether SB involvement exerts an impact on this cut-off. PATIENTS AND METHODS: Patients (n = 139) treated with CCRS plus HIPEC were prospectively verified and retrospectively analyzed. One hundred presented with SB involvement of different extents and at different locations. RESULTS: All the patients with a PCI ≥ 15 exhibited SB involvement. Five-year overall survival was 48% when the PCI was <15 vs 12% when it was ≥ 15 (p < 0.0001. The multivariate analysis retained two prognostic factors: PCI ≥ 15 (p = 0.02, HR = 1.8), and the involvement of area 12 (lower ileum) (p = 0.001, HR = 3.1). When area 12 was invaded, it significantly worsened the prognosis: 5-year overall survival of patients with a PCI <15 and area 12 involved was 15%, close to that of patients with a PCI ≥ 15 (12%) and far lower than that of patients with a PCI <15 and no area 12 involvement (70%). CONCLUSION: A PCI greater than 15 appears to be a relative contraindication for treatment of colorectal PM with CCRS + HIPEC. Involvement of the lower ileum is also a negative prognostic factor to be taken into consideration.
BACKGROUND: Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is on the verge of becoming the gold standard treatment for selected patients presenting peritoneal metastases (PM) of colorectal origin. PM is scored with the peritoneal cancer index (PCI), which is the main prognostic factor. However, small bowel (SB) involvement could exert an independent prognostic impact. AIM: To define an adequate cut-off for the PCI and to appraise whether SB involvement exerts an impact on this cut-off. PATIENTS AND METHODS: Patients (n = 139) treated with CCRS plus HIPEC were prospectively verified and retrospectively analyzed. One hundred presented with SB involvement of different extents and at different locations. RESULTS: All the patients with a PCI ≥ 15 exhibited SB involvement. Five-year overall survival was 48% when the PCI was <15 vs 12% when it was ≥ 15 (p < 0.0001. The multivariate analysis retained two prognostic factors: PCI ≥ 15 (p = 0.02, HR = 1.8), and the involvement of area 12 (lower ileum) (p = 0.001, HR = 3.1). When area 12 was invaded, it significantly worsened the prognosis: 5-year overall survival of patients with a PCI <15 and area 12 involved was 15%, close to that of patients with a PCI ≥ 15 (12%) and far lower than that of patients with a PCI <15 and no area 12 involvement (70%). CONCLUSION: A PCI greater than 15 appears to be a relative contraindication for treatment of colorectal PM with CCRS + HIPEC. Involvement of the lower ileum is also a negative prognostic factor to be taken into consideration.
Authors: Christos Iavazzo; Alexandros Fotiou; Victoria Psomiadou; Sofia Lekka; Dimitrios Katsanos; John Spiliotis Journal: Indian J Surg Oncol Date: 2021-03-03
Authors: Tinatin Kakchekeeva; Cedric Demtröder; Nirmitha I Herath; Dominic Griffiths; Jared Torkington; Wiebke Solaß; Marie Dutreix; Marc A Reymond Journal: Ann Surg Oncol Date: 2016-02-02 Impact factor: 5.344