Safety and efficacy of combined resection of colorectal peritoneal and liver metastases

Abstract

Background: To determine if a select subgroup of patients with combined liver and peritoneal colorectal metastases would derive oncologic benefit from surgical resection as a component of multimodality treatment.

Materials and methods: We retrospectively compared 32 patients with combined colorectal peritoneal and liver metastases (CRLM) and 173 patients with peritoneal metastases only (CRPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC). Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting survival.

Results: Major postoperative complications (Clavien-Dindo grades 3-5) occurred in 32% (CRLM) and 17% (CRPM) of patients (P = 0.08). After an estimated median follow-up from surgery of 57 mo, propensity score-adjusted median progression-free survival was 5.1 mo (CRLM) and 7.6 mo (CRPM), whereas median overall survival was 13 mo (CRLM) and 21 mo (CRPM). Multivariate Cox-regression analysis of the CRLM group identified number of liver metastases to be the only independent predictor of poor survival (hazard ratio: 2.3, P = 0.03), with a dramatic decrease in survival in patients with more than three liver metastases.

Conclusions: Simultaneous resection of colorectal liver metastases at the time of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion for peritoneal metastases may be associated with worse survival, especially in patients with more than three liver metastases.

Keywords: Colorectal cancer; Cytoreductive surgery; HIPEC; Metastases.

Figure 1

Kaplan-Meier survival curves (adjusted results by using propensity score weighting method) comparing combined colorectal liver and peritoneal metastases group (CRLM) and colorectal peritoneal metastases group (CRPM) treated with multimodality therapy including systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion. Propensity score adjusted estimated median progression-free survival (PFS) calculated from surgery was 5.1 months [95% CI 2.5, 9.1] for the CRLM group and 7.6 months [95% CI 6.1, 9.0] for the CRPM group (p=0.53).

Figure 2

Kaplan-Meier survival curves (adjusted results by using propensity score weighting method) comparing combined colorectal liver and peritoneal metastases group (CRLM) and colorectal peritoneal metastases group (CRPM) treated with multimodality therapy including systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion. Propensity score adjusted estimated median progression-free survival (PFS) calculated form the date of diagnosis of peritoneal metastases was 14.6 months [95% CI 8.4, 19.3] for the CRLM group and 14.8 months [95% CI 13.0, 18.8] for the CRPM group (p=0.88).

Figure 3

Kaplan-Meier survival curves (adjusted results by using propensity score weighting method) comparing combined colorectal liver and peritoneal metastases group (CRLM) and colorectal peritoneal metastases group (CRPM) treated with multimodality therapy including systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion. Propensity score adjusted estimated median overall survival (OS) calculated from surgery was 13 months [95% CI 7.4, 32.5] for the CRLM group and 20.5 months [95% CI 15.3, 30.1] for the CRPM group (p=0.16).

Figure 4

Kaplan-Meier survival curves (adjusted results by using propensity score weighting method) comparing combined colorectal liver and peritoneal metastases group (CRLM) and colorectal peritoneal metastases group (CRPM) treated with multimodality therapy including systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion. Propensity score adjusted estimated median overall survival (OS) calculated form the date of diagnosis of peritoneal metastases was 32.5 months [95% CI 15.0, 41.7] for the CRLM group and 36.2 months [95% CI 27.4, 43.6] for the CRPM group (p=0.21).