Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care?

Abstract

Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been demonstrated to have an improved survival over systemic chemotherapy for patients with colorectal peritoneal carcinomatosis (CRPC) in a randomized controlled trial. Despite the increasing clinical evidence, controversies still exist regarding the standard treatment for these patients.

Methods: Between January 1997 and October 2007, 50 patients with isolated CRPC underwent CRS and HIPEC at the St. George Hospital, Sydney. All patients underwent preoperative chest, abdominal and pelvic computed tomography scans, and positron emission tomography. All clinicopathologic and treatment-related data were obtained prospectively and computed in univariate and multivariate analyses to determine their prognostic significance for overall survival.

Results: The mean age at the time of CRS was 55 (SD = 14) years. There were 19 (38%) male patients. The overall median survival was 29 months (range 1-102) with a 3-year survival rate of 39%. Three clinicopathologic factors were found to be significant for overall survival: tumor differentiation (P < 0.001), peritoneal cancer index (P = 0.021), and completeness of cytoreduction (P < 0.001). In the multivariate analysis of overall survival, 2 factors were identified to be independently associated with an improved survival: well-differentiated tumor (P = 0.045) and complete cytoreduction (P = 0.023).

Conclusions: CRPC patients with low tumor volume, well/moderately differentiated tumors and complete cytoreduction may potentially benefit from the combined treatment. The combined treatment for patients with isolated colorectal peritoneal carcinomatosis should be considered to be the current standard of care.