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Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences is Safe and Efficacious

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for colorectal cancer peritoneal metastases (CRPM) is associated with improved survival in patients with historically dismal prognosis. Nonetheless, peritoneal recurrences remain common and represent a difficult challenge in these patients' management. Repeat CRS/HIPEC is associated with even greater morbidity and its survival benefit has not yet been clearly demonstrated.

Methods

We retrospectively reviewed our prospectively maintained database and aimed to assess the safety and oncological efficacy of repeat CRS/HIPEC.

Results

Two hundred thirty-two patients underwent an initial CRS/HIPEC, whereas 30 subsequently had repeat CRS/HIPEC for CRPM. Groups were similar in demographics, comorbidities, and peritoneal cancer index (PCI). No significant difference in morbidity, hospital stay, or reoperation rate was noted between initial and repeat procedures. Patients who underwent repeat CRS/HIPEC had a median overall survival of 68 months versus 51 months in patients who did not undergo repeat procedure for their peritoneal recurrence (p = 0.03). Disease-free survival (DFS) in patients after repeat and after initial procedure were similar with median of 9.6 versus 12 months, respectively (p = 0.083). Univariate analysis demonstrated that PCI, DFS, and repeat procedure displayed significant factors on outcomes in patients with peritoneal recurrences, whereas PCI > 16 and DFS remained independent predictors on multivariable analysis.

Conclusions

Our analysis, which represents the largest series to date of repeat CRS/HIPEC for CRPM, indicates that this approach as a part of multimodal therapy is both safe and efficacious in appropriately selected patients.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA. Jemal A (2020) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020;70(4):313. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.

    Article  PubMed  Google Scholar 

  2. Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg. 2006;243(2):212–22. https://doi.org/10.1097/01.sla.0000197702.46394.16.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Franko J, Ibrahim Z, Gusani NJ, Holtzman MP, Bartlett DL, Zeh HJ 3rd. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116(16):3756–62. https://doi.org/10.1002/cncr.25116.

    Article  PubMed  Google Scholar 

  4. Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32. https://doi.org/10.1245/s10434-008-9966-2.

    Article  PubMed  Google Scholar 

  5. Braam HJ, van Oudheusden TR, de Hingh IH, et al. Patterns of recurrence following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. J Surg Oncol. 2014;109(8):841–7. https://doi.org/10.1002/jso.23597.

    Article  PubMed  Google Scholar 

  6. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42. https://doi.org/10.1097/00000658-199501000-00004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.

    Article  PubMed  Google Scholar 

  8. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer. 1989;63(2):364–7. https://doi.org/10.1002/1097-0142(19890115)63:2%3c364::aid-cncr2820630228%3e3.0.co;2-v.

    Article  CAS  PubMed  Google Scholar 

  9. Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358–63. https://doi.org/10.1002/(sici)1097-0142(20000115)88:2%3c358::aid-cncr16%3e3.0.co;2-o.

    Article  CAS  PubMed  Google Scholar 

  10. Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89(12):1545–50. https://doi.org/10.1046/j.1365-2168.2002.02274.x.

    Article  CAS  PubMed  Google Scholar 

  11. Isacoff WH, Borud K. Chemotherapy for the treatment of patients with metastatic colorectal cancer: an overview. World J Surg. 1997;21(7):748–62. https://doi.org/10.1007/s002689900301.

    Article  CAS  PubMed  Google Scholar 

  12. Machover D. A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma. Cancer. 1997;80(7):1179–87. https://doi.org/10.1002/(sici)1097-0142(19971001)80:7%3c1179::aid-cncr1%3e3.0.co;2-g.

    Article  CAS  PubMed  Google Scholar 

  13. Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17(12):1709–19. https://doi.org/10.1016/S1470-2045(16)30500-9.

    Article  PubMed  Google Scholar 

  14. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284–92. https://doi.org/10.1200/JCO.2004.10.012.

    Article  CAS  PubMed  Google Scholar 

  15. Bijelic L, Yan TD, Sugarbaker PH. Failure analysis of recurrent disease following complete cytoreduction and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Ann Surg Oncol. 2007;14(8):2281–8. https://doi.org/10.1245/s10434-007-9410-z.

    Article  PubMed  Google Scholar 

  16. Portilla AG, Sugarbaker PH, Chang D. Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features. World J Surg. 1999;23(1):23–9. https://doi.org/10.1007/s002689900560.

    Article  CAS  PubMed  Google Scholar 

  17. Kianmanesh R, Scaringi S, Sabate JM, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases. Ann Surg. 2007;245(4):597–603. https://doi.org/10.1097/01.sla.0000255561.87771.11.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Williams BH, Alzahrani NA, Chan DL, Chua TC, Morris DL. Repeat cytoreductive surgery (CRS) for recurrent colorectal peritoneal metastases: yes or no? Eur J Surg Oncol. 2014;40(8):943–9. https://doi.org/10.1016/j.ejso.2013.10.022.

    Article  CAS  PubMed  Google Scholar 

  19. van Eden WJ, Elekonawo FMK, Starremans BJ, et al. Treatment of isolated peritoneal recurrences in patients with colorectal peritoneal metastases previously treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2018;25(7):1992–2001. https://doi.org/10.1245/s10434-018-6423-8.

    Article  PubMed  Google Scholar 

  20. Chua TC, Quinn LE, Zhao J, Morris DL. Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases. J Surg Oncol. 2013;108(2):81–8. https://doi.org/10.1002/jso.23356.

    Article  PubMed  Google Scholar 

  21. Wong JF, Tan GH, Wang W, Soo KC, Teo MC. Repeat cytoreductive surgery and HIPEC for peritoneal surface malignancy and peritoneal carcinomatosis. World J Surg. 2015;39(6):1578–83. https://doi.org/10.1007/s00268-015-2986-8.

    Article  PubMed  Google Scholar 

  22. Konstantinidis IT, Levine EA, Chouliaras K, Russell G, Shen P, Votanopoulos KI. Interval between cytoreductions as a marker of tumor biology in selecting patients for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2017;116(6):741–5. https://doi.org/10.1002/jso.24703.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Jost E, Mack LA, Sideris L, Dube P, Temple W, Bouchard-Fortier A. Evaluation of repeat cytoreductive surgery and heated intraperitoneal chemotherapy for patients with recurrent peritoneal carcinomatosis from appendiceal and colorectal cancers: a multicentre Canadian study. Can J Surg. 2020;63(1):E71–9. https://doi.org/10.1503/cjs.002519.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vaira M, Robella M, Mellano A, Sottile A, De Simone M. Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence. Int J Hyperthermia. 2014;30(8):565–9. https://doi.org/10.3109/02656736.2014.974693.

    Article  CAS  PubMed  Google Scholar 

  25. Choudry HA, Bednar F, Shuai Y, et al. Repeat cytoreductive surgery-hyperthermic intraperitoneal chemoperfusion is feasible and offers survival benefit in select patients with peritoneal metastases. Ann Surg Oncol. 2019;26(5):1445–53. https://doi.org/10.1245/s10434-019-07218-w.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bekhor E, Carr J, Hofstedt M, et al. The safety of iterative cytoreductive surgery and HIPEC for peritoneal carcinomatosis: a high volume center prospectively maintained database analysis. Ann Surg Oncol. 2020;27(5):1448–55. https://doi.org/10.1245/s10434-019-08141-w.

    Article  PubMed  Google Scholar 

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Funding

No external or commercial funding source was used for this research/manuscript.

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Authors and Affiliations

  1. Department of General and Oncological Surgery – Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel

    Shachar Laks MD, Gal Schtrechman MSc, Mohammad Adileh MD, Almog Ben-Yaacov MD, Vyacheslav Ivanov MA, Shani Goren MD & Aviram Nissan MD

  2. Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel

    Shachar Laks MD, Gal Schtrechman MSc, Mohammad Adileh MD, Almog Ben-Yaacov MD, Vyacheslav Ivanov MA, Dan Aderka MD, Einat Shacham-Shmueli MD, Naama Halpern MD, Shani Goren MD & Aviram Nissan MD

  3. Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel

    Dan Aderka MD, Einat Shacham-Shmueli MD & Naama Halpern MD

  4. Department of Oncology, Assuta Samson Hospital, Ashdod, Israel

    Ofer Purim MD

  5. Department of Anesthesiology, Chaim Sheba Medical Center, Ramat Gan, Israel

    Daria Perelson MD

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  1. Shachar Laks MD
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Laks, S., Schtrechman, G., Adileh, M. et al. Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences is Safe and Efficacious. Ann Surg Oncol 28, 5330–5338 (2021). https://doi.org/10.1245/s10434-021-09684-7

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  • DOI: https://doi.org/10.1245/s10434-021-09684-7

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