In:
World Journal of Surgery, Wiley, Vol. 48, No. 4 ( 2024-04), p. 871-878
Abstract:
Colorectal peritoneal metastases are a devastating consequence of colorectal cancer (CRC) with extremely poor prognosis. Patients that can undergo complete cytoreduction by cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) have a markedly improved overall survival. Traditionally, patients with extremely high peritoneal cancer index (PCI), PCI 〉 20, are not offered CRS/HIPEC. Methods We performed a retrospective analysis of our prospectively maintained CRS/HIPEC database and evaluated all patients with CRC peritoneal metastases between 2012 and 2022. We divided the cohorts between those with low operative PCI (PCI 〈 20) and high operative PCI (PCI = 〉 20). We examined demographic, clinicopathologic data, perioperative, and oncological outcomes between the cohorts. Results Of the 691 patients who underwent CRS/HIPEC, 289 were evaluable with CRC metastases, 234 with PCI 〈 20 and 43 with PCI = 〉 20. Median radiologic preoperative and operative PCI was 4 and 10 versus 7 and 24.5 in the low and high PCI cohorts, respectively. Operative time was longer (6 vs. 4 h) and blood loss higher (500 vs. 400 mL) in the high PCI cohort. All other demographic, clinicopathological, and operative characteristics were similar. Median disease free survival (DFS) was longer in the low PCI cohort (11.5 vs. 7 months) but overall survival (OS) showed benefit (41.3 vs. 31.8 months), ( p = 0.001 and p = 0.189, respectively), comparatively with an only chemotherapy strategy. Conclusions Appropriately selected patients with CRC metastases and extremely high PCI demonstrate similar perioperative safety outcomes in experienced tertiary referral centers. Despite a shorter median DFS, these carefully selected patients demonstrated similar median OS.
Type of Medium:
Online Resource
ISSN:
0364-2313
,
1432-2323
Language:
English
Publisher:
Wiley
Publication Date:
2024
detail.hit.zdb_id:
224043-9
detail.hit.zdb_id:
1463296-2
