Nayef A Alzahrani1,2, Sarah J Valle1, Oliver M Fisher1, Paul H Sugarbaker3, Yutaka Yonemura4, Olivier Glehen5, Dianne Goere6, Charles Honore6, Cecile Brigand7, Ignace de Hingh8, Vic J Verwaal8,9, Marcello Deraco10, Dario Baratti10, Shigeki Kusamura10, Mark Pocard11, Pompiliu Piso12, Loreen Maerz12, Frederic Marchal13, Brendan Moran14, Edward A Levine15, Frédéric Dumont16, Denis Pezet17, Karine Abboud18, Mathew A Kozman1, Winston Liauw1,19, David L Morris1. 1. St. George Hospital & University of New South Wales, Department of Surgery, Sydney, NSW, Australia. 2. College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia. 3. MedStar Washington Hospital Center, Peritoneal Surface Oncology Unit, Washington, DC. 4. Peritoneal Metastasis Center, Kishiwada Tokushukai Hospital, Osaka, Japan. 5. Surgical Oncology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France. 6. Institute Gustave Roussy Cancer Campus, Department of Digestive and Oncology Surgery, Paris, France. 7. General & Digestive Surgery, CHRU Hautepierre, Strasbourg, France. 8. Catharina Hospital, Department of Surgery, Eindhoven, Netherlands. 9. Department of Surgical Oncology, Aarhus University Hospital, Denmark. 10. Fondazione IRCCS Istituto Nazionale dei Tumori, Peritoneal Surface Malignancies Program, Milan, Italy. 11. Surgical Oncology Department, St. Louis Hospital Lariboisiere, Paris, France. 12. Department of Surgical Oncology, Hospital Barmherzige Brueder Regensburg, Germany. 13. Department of Surgical Oncology, Institute of Cancer, Vandoeeuvre Les Nancy, France. 14. Peritoneal Malignancy Department, Basingstoke North Hampshire Hospital, Basingstoke, UK. 15. Wake Forest Baptist Health, Surgical Oncology, Winston-Salem, North Carolina. 16. Surgical Oncology, René Gauducheau Cancer Center, Nantes, France. 17. Department of Digestive Surgery, CHU Estaing, Clermont Ferrand, France. 18. Department of General Surgery, CHU Nord, Saint Etienne, France. 19. Cancer Care Centre, St. George Hospital, Sydney, NSW, Australia.
Abstract
BACKGROUND AND OBJECTIVES: The aims of this multi-institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. METHODS: Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. RESULTS: The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high-grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence-free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5-year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11-20; P < 0.001 for PCI > 20), high-grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). CONCLUSION: iCRS can provide long-term survival benefits to highly selected colorectal peritoneal carcinomatosis patients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.
BACKGROUND AND OBJECTIVES: The aims of this multi-institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. METHODS:Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. RESULTS: The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high-grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence-free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5-year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11-20; P < 0.001 for PCI > 20), high-grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). CONCLUSION: iCRS can provide long-term survival benefits to highly selected colorectal peritoneal carcinomatosispatients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.
Authors: Benjamin D Powers; Seth Felder; Jula Veerapong; Joel M Baumgartner; Callisia Clarke; Harveshp Mogal; Charles A Staley; Shishir K Maithel; Sameer Patel; Vikrom Dhar; Laura Lambert; Ryan J Hendrix; Daniel E Abbott; Courtney Pokrzywa; Mustafa Raoof; Byrne Lee; Fabian M Johnston; Jonathan Greer; Jordan M Cloyd; Charles Kimbrough; Travis Grotz; Jennifer Leiting; Keith Fournier; Andrew J Lee; Iman Imanirad; Sophie Dessureault; Sean P Dineen Journal: Ann Surg Oncol Date: 2020-04-21 Impact factor: 5.344
Authors: Michel Adamina; Maxime Warlaumont; Martin D Berger; Silvio Däster; Raphaël Delaloye; Antonia Digklia; Beat Gloor; Ralph Fritsch; Dieter Koeberle; Thibaud Koessler; Kuno Lehmann; Phaedra Müller; Ralph Peterli; Frédéric Ris; Thomas Steffen; Christian Stefan Weisshaupt; Martin Hübner Journal: Cancers (Basel) Date: 2022-09-01 Impact factor: 6.575