Skip to main content

Advertisement

Log in

Extent of Colorectal Peritoneal Carcinomatosis: Attempt to Define a Threshold Above Which HIPEC Does Not Offer Survival Benefit: A Comparative Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The main prognostic factors after complete cytoreductive surgery (CCRS) of colorectal peritoneal carcinomatosis (PC) followed by intraperitoneal chemotherapy (IPC) are completeness of the resection and extent of the disease. This study aimed to determine a threshold value above which CCRS plus IPC may not offer survival benefit compared with systemic chemotherapy.

Methods

Between March 2000 and May 2010, 180 patients underwent surgery for PC from colorectal cancer with intended performance of CCRS plus IPC.

Results

Among the 180 patients, CCRS plus IPC could be performed for 139 patients (curative group, 77 %), whereas it could not be performed for 41 patients (palliative group, 23 %). The two groups were comparable in terms of age, gender, primary tumor characteristics, and pre- and postoperative systemic chemotherapy. The mean peritoneal cancer index (PCI) was lower in the curative group (11 ± 7) than in the palliative group (23 ± 7) (p < 0.0001). After a median follow-up period of 60 months (range 47–74 months), the 3-year overall survival (OS) rate was 52 % [95 % confidence interval (CI) 43–61 %] in the curative group compared with 7 % (95 % CI 2–25 %) in the palliative group. Comparison of the survivals for each PCI (ranging from 5 to 36) shows that OS did not differ significantly between the two groups of patients when the PCI was higher than 17 (hazard ratio 0.64; range 0.38–1.09).

Conclusion

This study confirmed the major prognostic impact of PC extent. When the PCI exceeds 17 in PC of colorectal origin, CCRS plus IPC does not seem to offer any survival benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jayne DG, Fook S, Loi C, et al. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89:545–50.

    Google Scholar 

  2. Sugarbaker PH, Gianola FJ, Speyer JC, et al. Prospective, randomized trial of intravenous versus intraperitoneal 5-fluorouracil in patients with advanced primary colon or rectal cancer. Surgery. 1985;98:414–22.

    CAS  PubMed  Google Scholar 

  3. Verwaal VC, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis from colorectal cancer. J Clin Oncol 2003;21:3737–43.

    Article  PubMed  Google Scholar 

  4. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with intraperitoneal chemotherapy for management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.

    Article  CAS  PubMed  Google Scholar 

  5. Esquivel J, Elias D, Baratti D, et al. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol. 2008;98:263–7.

    Article  PubMed  Google Scholar 

  6. Elias D, Lefèvre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.

    Article  PubMed  Google Scholar 

  7. Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg. 2008;248:829–35.

    PubMed  Google Scholar 

  8. Verwaal VJ, Bruin S, Boot H, et al. 8-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. 2008;15:2426–32.

    Article  PubMed  Google Scholar 

  9. Elias D, Glehen O, Pocard M, et al. A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg. 2010;251:896–901.

    Article  PubMed  Google Scholar 

  10. Goéré D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257:1065–71.

    Article  PubMed  Google Scholar 

  11. Verwaal VJ, van Tinteren H, van Ruth S, et al. Predicting the survival of patients with peritoneal carcinomatosis of colorectal origin treated by aggressive cytoreduction and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2004;91:739–4.

    Article  Google Scholar 

  12. Yan T, Sim J, Morris DL. Selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2007;14:1807–17.

    Article  PubMed  Google Scholar 

  13. Franko J, Ibrahim Z, Gusani NJ, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116:3756–62.

    Article  PubMed  Google Scholar 

  14. Hompes D, Boot H, van Tinteren H, et al. Unresectable peritoneal carcinomatosis from colorectal cancer: a single-center experience. J Surg Oncol. 2011;104:269–73.

    Article  PubMed  Google Scholar 

  15. Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from nongynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88:358–63.

    Article  CAS  PubMed  Google Scholar 

  16. Franko J, Shi Q, Goldman CD. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of north central cancer treatment group phase III trials N9741 and N9841. J Clin Oncol. 2012;30:263–7.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Jacquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res. 1996;15:49–58.

    Google Scholar 

  18. Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer. 2001;92:71–6.

    Article  CAS  PubMed  Google Scholar 

  19. Gomes da Silva RG, Sugarbaker PH. Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. J Am Coll Surg. 2006;203:878–86.

    Article  Google Scholar 

  20. Cao C, Yan TD, Black D, Morris DL. A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2009;16:2152–65.

    Article  PubMed  Google Scholar 

  21. Esquivel J, Sticca R, Sugarbaker P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol. 2007;14:128–33.

  22. Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8.

    Article  PubMed  Google Scholar 

  23. Cotte E, Passot G, Gilly FN, et al. Selection of patients and staging of peritoneal surface malignancies. World J Gastrointest Oncol. 2010;2:31–5.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Cashin PH, Graf W, Nygren P, et al. Patient selection for cytoreductive surgery in colorectal peritoneal carcinomatosis using serum tumor markers: an observational cohort study. Ann Surg. 2012;256:1078–83.

    Article  PubMed  Google Scholar 

  25. Passot G, Vaudoyer D, Cotte E, et al. Progression following neoadjuvant systemic chemotherapy may not be a contraindication to a curative approach for colorectal carcinomatosis. Ann Surg. 2012;256:125–9.

    Article  PubMed  Google Scholar 

  26. Sanoff HK, Sargent DJ, Campbell ME, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26:5721–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Elias D, Souadka A, Fayard F, et al. Variation in the peritoneal cancer index scores between surgeons and according to when they are determined (before or after cytoreductive surgery). Eur J Surg Oncol. 2012;38:503–8.

    Article  CAS  PubMed  Google Scholar 

  28. de Bree E, Koops W, Kröger R, et al. Preoperative computed tomography and selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2006;32:65–71.

    Article  PubMed  Google Scholar 

  29. Dromain C, Leboulleux S, Auperin A, et al. Staging of peritoneal carcinomatosis: enhanced CT vs PET/CT. Abdom Imaging. 2008;33:87–93.

    Article  PubMed  Google Scholar 

  30. Swellengrebel HA, Zoetmulder FA, Smeenk RM, et al. Quantitative intraoperative assessment of peritoneal carcinomatosis: a comparison of three prognostic tools. Eur J Surg Oncol. 2009;35:1078–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Diane Goéré MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2015_4387_MOESM1_ESM.eps

Overall survival curves according to the extent of peritoneal carcinomatosis (PCI) and the possibility of performing complete cytoreductive surgery plus intraperitoneal chemotherapy (curative group = red, blue, green, purple, and orange curves; palliative group = brown curve). When the PCI was higher than 20, the median overall survival did not differ significantly between the two groups. Supplementary material 1 (EPS 613 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goéré, D., Souadka, A., Faron, M. et al. Extent of Colorectal Peritoneal Carcinomatosis: Attempt to Define a Threshold Above Which HIPEC Does Not Offer Survival Benefit: A Comparative Study. Ann Surg Oncol 22, 2958–2964 (2015). https://doi.org/10.1245/s10434-015-4387-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4387-5

Keywords

Navigation