The role of cytoreductive surgery alone for the treatment of peritoneal carcinomatosis of colorectal origin. A retrospective analysis with regard to multimodal treatments.
OBJECTIVE
Patients with peritoneal carcinomatosis (PC) of colorectal origin have a poor prognosis (median survival of 6 months). Cytoreductive surgery (CS) with intra-peritoneal chemotherapy with or without hyperthermia (HIPEC or EPIC) allows encouraging survivals rates of 22-60 months to be obtained, with an acceptable mortality and morbidity. Nevertheless, the role of cytoreductive surgery alone is little explored in literature. The aim of this study was to better understand the role of CS alone in the treatment of PC of colorectal origin.


METHODS
The outcome of 27 patients with PC of colorectal origin who underwent surgery with curative intent without combined treatments from 1996 to 2006, has been retrospectively analyzed.


RESULTS
the median overall survival rate was 15 months; there was a significant statistical difference between patients who had CCR0-1 surgery (N=22) and those who had CCR2 or no resection (N=5) (15.8 vs. 9.6 months respectively, p=0.02). The mortality and the morbidity rates were 7.3% and 29%.


CONCLUSIONS
This study suggests that CCR0-1 surgery alone as well as the extension of the disease are important variables influencing survival of patients with PC of colorectal origin. When a very aggressive procedure is needed to achieve a CCR0 resection, surgery should be considered rigorously because of the high risk of severe and potentially lethal complications even without chemohyperthermia. A prospective study should be realized to determine whether or not patients with PC could mostly benefit from combined treatments.
Scaringi
Stefano
S
Surgery Unit, Department of Clinical Physiopathology, University of Florence Medical School, Careggi University Hospital, Florence, Italy.
Leo
Francesca
F
Canonico
Giuseppe
G
Batignani
Giacomo
G
Ficari
Ferdinando
F
Tonelli
Francesco
F
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome