Peritoneal carcinomatosis from adenocarcinoma of the colon

Abstract

Peritoneal carcinomatosis is a major cause of surgical treatment failure in patients with colorectal cancer. Patients with this condition have in the past always had a lethal outcome. We reviewed the results of 56 consecutive patients treated by the cytoreductive approach. This involved surgery to maximally resect all cancer in the abdomen and pelvis in combination with early postoperative intraperitoneal chemotherapy with 5-fluorouracil (5-FU) and mitomycin C. All patients also had three cycles of adjuvant intraperitoneal 5-FU with systemic mitomycin C. An assessment of the clinical features that may affect prognosis was performed and critically analyzed statistically. A significant clinical feature was defined as one with a p value > or = 0.05. Small lesion size of implants present in the abdomen and pelvis at the time of exploration correlated with a good prognosis (p = 0.0025). A complete cytoreduction with tumor removed to < 0.25 cm correlated with a good prognosis (p = 0.0001). A limited involvement of the five abdominal regions was an important determinant of prognosis, with a p value of 0.0739. Finally, a mucinous histologic type correlated adversely with prognosis when compared with adenocarcinomas (p = 0.0434). These data taken together may suggest that patients with small-volume peritoneal seeding should routinely be treated with cytoreductive surgery and aggressive regional and systemic chemotherapy in an attempt to achieve long-term disease-free survival in this group of poor prognosis patients.