title: Peritoneal metastases of lower gastrointestinal tract origin: a comparative study of patient outcomes following cytoreduction and intraperitoneal chemotherapy.
abstract: BACKGROUND
  Cytoreductive surgery (CS) combined with intraperitoneal chemotherapy (IPC) is a multimodal approach to the treatment of peritoneal metastases (PM) of lower gastrointestinal origin. This study examines patient outcomes and critically evaluates its patterns of recurrences relative to the site of metastatic origin.
  
  
  METHODS
  Patients treated with CS/IPC from 2000 to 2012 where PM arose from a primary tumour of the appendix, colon and rectum were identified from a prospective database for retrospective evaluation. The primary end points were survival (overall and disease-free), and secondary end points include patterns of recurrence and prognostic factors associated with overall outcomes.
  
  
  RESULTS
  Two hundred and eleven patients were followed up for a median of 23.3 months (range 1-156). Overall median survival was 46.8 months, and the 1-, 3-, 5-year survival rates were 87, 56 and 42 %, respectively. The 5-year survival of patients with appendiceal, colonic and rectal PM was 55, 33 and 20 %, respectively. Tumour origin was the only independent prognostic factor associated with overall survival (p = 0.03). Recurrences were more common in patients of colorectal origin over appendiceal origin (p < 0.001) and were more likely to be of a systemic nature (p = 0.05).
  
  
  CONCLUSIONS
  CS/IPC provides an option for improved survival in patients with PM of lower gastrointestinal origin and appears to be most promising in patients with disease of appendiceal origin.
authors.affiliation: UNSW Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia.
authors.forename: Lawson
authors.initials: L
authors.lastname: Ung
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
references.citation: N Engl J Med. 2004 Jun 3;350(23):2335-42
references.pmid: 15175435
references.citation: Cancer. 2010 Dec 15;116(24):5608-18
references.pmid: 20737573
references.citation: Scand J Gastroenterol. 2012 Mar;47(3):277-85
references.pmid: 22263634
references.citation: J Clin Oncol. 2004 Aug 15;22(16):3284-92
references.pmid: 15310771
references.citation: Ann Oncol. 2012 Mar;23(3):652-658
references.pmid: 21653683
references.citation: Gan To Kagaku Ryoho. 2004 Aug;31(8):1187-92
references.pmid: 15332541
references.citation: J Clin Oncol. 2007 Oct 20;25(30):4779-86
references.pmid: 17947725
references.citation: Ann Surg Oncol. 2009 Aug;16(8):2152-65
references.pmid: 19434455
references.citation: Ann Surg. 1995 Feb;221(2):124-32
references.pmid: 7857141
references.citation: J Clin Oncol. 2005 Aug 1;23(22):4866-75
references.pmid: 15939922
references.citation: J Clin Oncol. 2007 Sep 20;25(27):4224-30
references.pmid: 17548839
references.citation: Cancer J. 2009 May-Jun;15(3):225-35
references.pmid: 19556909
references.citation: Eur J Cancer. 2012 Jul;48(10):1466-75
references.pmid: 22446022
references.citation: Arch Pathol Lab Med. 2002 Jul;126(7):837-41
references.pmid: 12088454
references.citation: J Clin Oncol. 2012 Jan 20;30(3):263-7
references.pmid: 22162570
references.citation: Ann Oncol. 2012 Jun;23(6):1494-8
references.pmid: 22056853
references.citation: Ann Surg. 2010 May;251(5):896-901
references.pmid: 20395843
references.citation: J Clin Oncol. 2007 Sep 20;25(27):4217-23
references.pmid: 17548840
references.citation: J Clin Oncol. 2003 Oct 15;21(20):3737-43
references.pmid: 14551293
references.citation: Cancer. 2000 Jan 15;88(2):358-63
references.pmid: 10640968
references.citation: J Clin Oncol. 2012 Jul 10;30(20):2449-56
references.pmid: 22614976
references.citation: Pathol Oncol Res. 2009 Dec;15(4):671-8
references.pmid: 19401830
references.citation: Clin Colon Rectal Surg. 2005 Aug;18(3):190-203
references.pmid: 20011302
references.citation: J Clin Oncol. 2008 Feb 1;26(4):689-90
references.pmid: 18235136
references.citation: Semin Surg Oncol. 1998 Apr-May;14(3):254-61
references.pmid: 9548609