Peritoneal metastases of lower gastrointestinal tract origin:a comparative study of patient outcomes following cytoreduction and intraperitoneal chemotherapy.
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 endpoints 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.
Third Department of Internal Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany, thomas.wehler@unimedizin-mainz.de.
Lawson
L
Ung
Terence C
TC
Chua
Morris
M
David L
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000368:Aged; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate