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Meta-Analysis
. 2022 Oct;29(11):6619-6631.
doi: 10.1245/s10434-022-11699-7. Epub 2022 Apr 9.

The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

Michael P Flood  1   2 , Joseph C H Kong  3   4 , Kasmira Wilson  3   4 , Helen Mohan  3 , Peadar S Waters  3 , Jacob J McCormick  3 , Satish K Warrier  3 , Jeanne Tie  4   5 , Robert Ramsay  3   4 , Michael Michael  4   5 , Alexander G Heriot  3   4
Affiliations
Meta-Analysis

The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

Michael P Flood et al. Ann Surg Oncol. 2022 Oct.

Abstract

Background: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-recognised treatment option for the management of colorectal peritoneal metastases (CRPM). However, incorporating the routine use of neoadjuvant chemotherapy (NAC) into this management plan is controversial.

Methods: A systematic review and meta-analysis were conducted to evaluate the impact of neoadjuvant chemotherapy on perioperative morbidity and mortality, and long-term survival of patients with CRPM undergoing CRS and HIPEC.

Results: Twelve studies met the inclusion criteria (n = 2,463 patients). Ten were retrospective cohort, one was prospective cohort, and one was a prospective randomised by design. Patients who received NAC followed by CRS and HIPEC experienced no difference in major perioperative morbidity and mortality compared with patients who underwent surgery first (SF). There was no difference in overall survival at 3 years, but at 5 years NAC patients had superior survival (relative risk [RR] 1.31; 95% confidence interval [CI] 1.11-1.54, P < 0.001). There were no differences in 1- and 3-year, disease-free survival (DFS) between groups. Study heterogeneity was generally high across all outcome measures.

Conclusions: Patients who received neoadjuvant chemotherapy did not experience any increase in perioperative morbidity or mortality. The potential improvement in 5-year overall survival in patients receiving NAC is based on limited confidence due to several limitations in the data, but not sufficiently enough to curtail its use. The practice of NAC in this setting will remain heterogeneous and guided by retrospective evidence until prospective, randomised data are reported.

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Conflict of interest statement

The authors have no conflicts of interest. There is no grant support or financial relationship associated with this study.

Figures

Fig. 1
Fig. 1
Flow diagram of selected studies
Fig. 2
Fig. 2
Forrest plot demonstrating perioperative mortality risk associated with neoadjuvant chemotherapy compared to surgery first
Fig. 3
Fig. 3
Forrest plot demonstrating the risk of perioperative major morbidity with neoadjuvant chemotherapy compared to surgery first
Fig. 4
Fig. 4
Forrest plot demonstrating the meta-analysis of 3-year overall survival
Fig. 5
Fig. 5
Forrest plot demonstrating the meta-analysis of 5-year overall survival
Fig. 6
Fig. 6
Forrest plot demonstrating the meta-analysis of 1-year disease-free survival
Fig. 7
Fig. 7
Forrest plot demonstrating the meta-analysis of 3-year disease-free survival
See this image and copyright information in PMC

Comment in

References

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