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Is There a Possibility of a Cure in Patients With Colorectal Peritoneal Carcinomatosis Amenable to Complete Cytoreductive Surgery and Intraperitoneal Chemotherapy?

2013; Lippincott Williams & Wilkins; Volume: 257; Issue: 6 Linguagem: Inglês

10.1097/sla.0b013e31827e9289

1528-1140

Diane Goèré, David Malka, Dimitri Tzanis, Vinícius Grando Gava, Valérie Boige, Clarisse Eveno, Léon Maggiori, Frédéric Dumont, Michel Ducreux, Dominique Élias,

Appendicitis Diagnosis and Management

In Brief Background: Although a randomized trial demonstrated a survival benefit of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) over systemic chemotherapy alone, the treatment of peritoneal carcinomatosis from colorectal cancer (CRPC) is still a matter of debate. The aims of this study were to evaluate long-term outcome after CRS and IPC and to identify the prognostic factors associated with a cure. Methods: Patients were considered cured if the disease-free survival interval lasted at least 5 years after the treatment of CRPC or its last recurrence. Patients who had died postoperatively, or from non–cancer-related deaths, or patients with a follow-up of less than 5 years since the last curative treatment were excluded from the analysis. Results: From 1995 to 2006, 107 patients (median age, 48 years; range, 19–67 years) underwent complete CRS, followed by IPC. Postoperative complications occurred in 50 patients (53%), including 4 postoperative deaths. After a median follow-up of 77 months (range, 60–144 months), 5-year and 10-year overall survival rates were 35% and 15%, respectively. Seventeen patients (16%) were considered cured after a disease-free interval of at least 5 years, of whom 14 never developed a recurrence. Cured patients had a significantly lower median peritoneal cancer index than noncured patients, respectively 4 (3–16) and 12 (2–36) (P = 0.0002). In multivariate analysis, a peritoneal cancer index of 10 or less was the only independent factor predicting cure. Conclusions: The cure rate (16%) after complete CRS of colorectal peritoneal carcinomatosis, followed by IPC, in selected patients is close to that obtained after resection of colorectal liver metastases. From 1995 to 2006, 107 patients underwent complete cytoreductive surgery, followed by intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. Seventeen patients (16%) were considered cured after a disease-free interval of at least 5 years. This cure rate of 16% is close to that obtained after resection of colorectal liver metastases.