title: Modified selection criteria for complete cytoreductive surgery plus HIPEC based on peritoneal cancer index and small bowel involvement for peritoneal carcinomatosis of colorectal origin.
abstract: BACKGROUND
  Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is on the verge of becoming the gold standard treatment for selected patients presenting peritoneal metastases (PM) of colorectal origin. PM is scored with the peritoneal cancer index (PCI), which is the main prognostic factor. However, small bowel (SB) involvement could exert an independent prognostic impact.
  
  
  OBJECTIVE
  To define an adequate cut-off for the PCI and to appraise whether SB involvement exerts an impact on this cut-off.
  
  
  METHODS
  Patients (n = 139) treated with CCRS plus HIPEC were prospectively verified and retrospectively analyzed. One hundred presented with SB involvement of different extents and at different locations.
  
  
  RESULTS
  All the patients with a PCI ≥ 15 exhibited SB involvement. Five-year overall survival was 48% when the PCI was <15 vs 12% when it was ≥ 15 (p < 0.0001. The multivariate analysis retained two prognostic factors: PCI ≥ 15 (p = 0.02, HR = 1.8), and the involvement of area 12 (lower ileum) (p = 0.001, HR = 3.1). When area 12 was invaded, it significantly worsened the prognosis: 5-year overall survival of patients with a PCI <15 and area 12 involved was 15%, close to that of patients with a PCI ≥ 15 (12%) and far lower than that of patients with a PCI <15 and no area 12 involvement (70%).
  
  
  CONCLUSIONS
  A PCI greater than 15 appears to be a relative contraindication for treatment of colorectal PM with CCRS + HIPEC. Involvement of the lower ileum is also a negative prognostic factor to be taken into consideration.
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France. Electronic address: dominique.elias@gustaveroussy.fr.
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: A
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Cloutier
authors.affiliation: Intensive Care Unit, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: F
authors.initials: F
authors.lastname: Blot
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: D
authors.initials: D
authors.lastname: Goéré
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.affiliation: Department of Anesthesiology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: V
authors.initials: V
authors.lastname: Billard
authors.affiliation: Department of Pathology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: P
authors.initials: P
authors.lastname: Dartigues
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, 94805 Villejuif Cédex, France.
authors.forename: M
authors.initials: M
authors.lastname: Ducreux
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002277:Carcinoma / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007078:Ileal Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D007263:Infusions, Parenteral; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery*; D000077146:Irinotecan; D007580:Jejunal Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D018579:Patient Selection; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002166:Camptothecin
keywords: Colorectal cancer; Peritoneal cancer index; Peritoneal metastases; Small bowel involvement