title: Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases.
abstract: BACKGROUND
  The aim of this study was to evaluate the results of an aggressive strategy in patients presenting peritoneal carcinomatosis (PC) from colorectal cancer with or without liver metastases (LMs) treated with cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  METHODS
  The population included 43 patients who had 54 CS+HIPEC for colorectal PC from 1996 to 2006. Sixteen patients (37%) presented LMs. Eleven patients (25%) presented occlusion at the time of PC diagnosis. Ascites was present in 12 patients (28%). Seventy-seven percent of the patients were Gilly 3 (diffuse nodules, 5-20 mm) and Gilly 4 (diffuse nodules>20 mm). The main endpoints were morbidity, mortality, completeness of cancer resection (CCR), and actuarial survival rates.
  
  
  RESULTS
  The CS was considered as CCR-0 (no residual nodules) or CCR-1 (residual nodules <5 mm) in 30 patients (70%). Iterative procedures were performed in 26% of patients. Three patients had prior to CS + HIPEC, 10 had concomitant minor liver resection, and 3 had differed liver resections (2 right hepatectomies) 2 months after CS + HIPEC. The mortality rate was 2.3% (1 patient). Seventeen patients (39%) presented one or multiple complications (per procedure morbidity = 31%). Complications included deep abscess (n = 6), wound infection (n = 5), pleural effusion (n = 5), digestive fistula (n = 4), delayed gastric emptying syndrome (n = 4), and renal failure (n = 3). Two patients (3.6%) were reoperated. The median survival was 38.4 months (CI, 32.8-43.9). Actuarial 2- and 4-year survival rates were 72% and 44%, respectively. The survival rates were not significantly different between patients who had CS + HIPEC for PC alone (including the primary resection) versus those who had associated LMs resection (median survival, 35.3 versus 36.0 months, P = 0.73).
  
  
  CONCLUSIONS
  Iterative CS + HIPEC is an effective treatment in PC from colorectal cancer. The presence of resectable LMs associated with PC does not contraindicate the prospect of an oncologic treatment in these patients.
authors.affiliation: Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris, Paris-VII University (GHU Nord), Colombes, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.forename: Stefano
authors.initials: S
authors.lastname: Scaringi
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sabate
authors.forename: Benjamin
authors.initials: B
authors.lastname: Castel
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pons-Kerjean
authors.forename: Benoit
authors.initials: B
authors.lastname: Coffin
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Hay
authors.forename: Yves
authors.initials: Y
authors.lastname: Flamant
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
mesh_terms: D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D012004:Rectal Neoplasms / Q000473:pathology*; D016019:Survival Analysis