Multivisceral resection does not affect morbidity and survival after cytoreductive surgery and chemoperfusion for carcinomatosis from colorectal cancer.
BACKGROUND
Carcinomatosis of colorectal origin is increasingly treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS-HIPEC). This procedure commonly involves multivisceral resection (MVR) with potentially high morbidity. We analyzed the effect of MVR on the outcome after CS-HIPEC.


METHODS
All patients with colorectal carcinomatosis operated between June 2001 and June 2007 were included. MVR was defined as resection of two or more organs (n = 35). Patients without any or with a single visceral resection formed a control group (n = 30).


RESULTS
Sixty-five patients underwent 72 procedures. MVR was not strongly associated with the mortality, morbidity, reoperation, or readmission. Morbidity, but not mortality, was more common in patients requiring bowel anastomosis (36 of 51 vs. 7 of 21, P = .003). Median survival from the diagnosis of carcinomatosis was not significantly different between the MVR and controls (32.8 months vs. 20.0 months, P = .787). Similarly, the median survival from the time of cytoreduction was not significantly different (20.2 vs. 14.3 months; P = .436). Independent predictors of survival in the Cox regression model were presence of residual disease >5 mm (hazard ratio = 4.5, P = .048), evidence of carcinomatosis on preoperative computed tomographic scan (6.1, P = .008), and initial diagnosis of cancer as systemic (2.6, P = .049). MVR had no statistically significant effect on survival (.441, P = .133).


CONCLUSIONS
Increased risk of complications is associated with the number of intestinal anastomoses, but not with multivisceral resection in CS-HIPEC. Long-term survival is not affected by the number of resected organs.
Franko
Jan
J
Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Rm 414, Pittsburgh, PA 15232, USA. jan.franko@gmail.com
Gusani
Niraj J
NJ
Holtzman
Matthew P
MP
Ahrendt
Steven A
SA
Jones
Heather L
HL
Zeh
Herbert J
HJ
Bartlett
David L
DL
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome