Outcomes associated with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy in colorectal cancer patients with peritoneal surface disease and hepatic metastases.
BACKGROUND
Cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) can improve outcomes for selected patients with peritoneal carcinomatosis (PC) from colorectal cancer. The presence of parenchymal hepatic metastases (HM) is considered a relative contraindication for CS and IPHC. The purpose of the current study was to compare the overall survival of patients with HM to those without and to examine predictive factors.


METHODS
This was a retrospective study of patients undergoing CS and IPHC between 1991 and 2007. Clinicopathologic information was obtained from a prospectively collected database and electronic medical records. Univariate and multivariate analyses were performed to evaluate variables predictive for overall survival.


RESULTS
There were 142 patients who underwent CS and IPHC for PC from colorectal cancer, with 14 (9.9%) patients noted to have concurrent HM. The median number and size of the liver lesions was 1 (range, 1-7 lesions) and 3.0 cm (range, 0.4 cm-12 cm), respectively. The median overall survival for patients with HM was 23.0 months. Two-year and 4-year survival rates were 43.3% and 14.4%, respectively. Patients without HM had 2-year and 4-year survival rates of 36.8% and 17.4%, respectively. Overall survival was not significantly different for patients with and without HM (log-rank P=.39).


CONCLUSIONS
Patients with HM undergoing CS and IPHC for colorectal cancer were found to have no significant difference in overall survival compared with those without HM. Most patients had a single small lesion treated with a minor hepatic resection. Further study is indicated to define which patients with HM benefit most from this multimodality approach.
Varban
Oliver
O
Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Levine
Edward A
EA
Stewart
John H
JH
McCoy
Thomas P
TP
Shen
Perry
P
D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008113:Liver Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D016685:Mitomycin