Complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastasis in Norway: Prognostic factors and oncologic outcome in a national patient cohort

J Surg Oncol. 2016 Aug;114(2):222-7. doi: 10.1002/jso.24290. Epub 2016 May 12.

Abstract

Background and objectives: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can offer long-term survival to patients with resectable peritoneal metastasis (PM) from colorectal cancer (CRC), a condition with otherwise dismal prognosis. This study describes short- and long-term outcome in a national patient cohort and aims to identify prognostic factors.

Methods: All patients treated with CRS-HIPEC for non-appendiceal PM-CRC in Norway 2004-2013 were included (n = 119), and outcome and potential prognostic factors were examined using survival- and ROC-curve analysis.

Results: Five-year overall survival (OS) and disease-free survival (DFS) were 36% and 14%, respectively, with 45 months median follow-up. The only factor associated with OS in multivariable analysis was peritoneal cancer index (PCI), with HR 1.05 (1.01-1.09) for every increase in PCI-score (P = 0.015). Peritoneal relapse was associated with shorter OS than distant metastasis (P = 0.002). ROC-curves identified PCI > 12 as a marker with 100% specificity for prediction of disease relapse. Severe postoperative complications (Clavien-Dindo ≥ 3) occurred in 15% of patients and there was no 100-day mortality.

Conclusions: Long-term outcome was in line with published results, morbidity was acceptable and there was no 100-day mortality. The results reemphasize CRS-HIPEC as an important treatment option in PM-CRC, with particularly good results in patients with PCI < 12. J. Surg. Oncol. 2016;114:222-227. © 2016 Wiley Periodicals, Inc.

Keywords: colorectal cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; peritoneal metastasis.

MeSH terms

  • Adult
  • Aged
  • Antibiotics, Antineoplastic / administration & dosage
  • Colorectal Neoplasms / pathology*
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures*
  • Female
  • Humans
  • Hyperthermia, Induced
  • Male
  • Middle Aged
  • Mitomycin / administration & dosage
  • Norway
  • Peritoneal Neoplasms / secondary*
  • Peritoneal Neoplasms / therapy*
  • Postoperative Complications
  • Prognosis
  • ROC Curve
  • Survival Analysis
  • Treatment Outcome
  • Young Adult

Substances

  • Antibiotics, Antineoplastic
  • Mitomycin