title: Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases.
abstract: OBJECTIVE
  A major problem in treating patients with peritoneal spread from colorectal cancer is that at diagnosis wide peritoneal involvement often precludes all curative attempts. A possible solution is to identify those patients at risk for peritoneal metastases and intervene early to prevent locoregional disease spread before it develops and, thus, to improve outcome.
  
  
  METHODS
  We analyzed long-term results from a previous study and compared outcomes in 25 patients with advanced colon cancer considered at high risk for peritoneal spread (pT3/pT4 and mucinous or signet ring cell histology) prospectively included and managed with a proactive surgical approach including target organ resection for peritoneal spread plus hyperthermic intraperitoneal chemotherapy (HIPEC) and in 50 retrospectively well-matched controls who underwent standard surgical resection during the same period and in the same hospital by different surgical teams.
  
  
  RESULTS
  At 48 months after the study closed, peritoneal metastases and local recurrence developed significantly less often in proactively managed patients than in controls (4 vs 28%) (p < 0.03). Patients in the proactive group also survived longer than control patients (median overall survival 59.5 vs 52 months). Despite similar morbidity, Kaplan-Meier survival curves disclosed significantly longer disease-free and overall survival in the proactive than in the control group (p < 0.05 and <0.04).
  
  
  CONCLUSIONS
  In patients with advanced colon cancer at risk for peritoneal recurrence, the proactive surgical approach plus HIPEC seems to achieve good locoregional control preventing peritoneal spread thus improving outcome without increasing morbidity. These advantages merit investigation in a multicentric randomized trial.
authors: Department of Surgery "Pietro Valdoni", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00155, Rome, Italy, paolo.sammartino@uniroma1.it.
authors: P
authors: P
authors: Sammartino
authors: S
authors: S
authors: Sibio
authors: D
authors: D
authors: Biacchi
authors: M
authors: M
authors: Cardi
authors: P
authors: P
authors: Mingazzini
authors: M S
authors: MS
authors: Rosati
authors: T
authors: T
authors: Cornali
authors: B
authors: B
authors: Sollazzo
authors: J Maherfouad
authors: JM
authors: Atta
authors: A
authors: A
authors: Di Giorgio
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000517:prevention & control* / Q000556:secondary*; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin