title: Cytoreductive surgery of colorectal peritoneal metastases: outcomes after complete cytoreductive surgery and systemic chemotherapy only.
abstract: BACKGROUND
  Cytoreductive peritoneal surgery (CRS) associated with hyperthermic peritoneal chemotherapy (HIPEC) has long been considered the standard treatment for colorectal peritoneal metastases (CPM). However, although efficacy of surgery has been demonstrated, evidence supporting HIPEC's role is less certain.
  
  
  METHODS
  Overall survival (OS), progression-free survival (PFS) and morbidity were analysed retrospectively for fifty consecutively included patients treated for colorectal CPM with complete CRS and systemic chemotherapy only.
  
  
  RESULTS
  Median peritoneal cancer index (PCI) was 8 (range 1-24). 23 patients had liver or lung metastases (LLM). 22 patients had synchronous CPM. 27 complications occurred (12 Grade 1/2, 14 Grade 3, 1 Grade 4a, 0 Grade 5). Median follow-up was 62.5 months (95 %CI 45.4-81.3), median survival 32.4 months (21.5-41.7). Three- and 5-year OS were 45.5% (0.31-0.59) and 29.64% (0.17-0.44) respectively. Presence of LLMs associated with peritoneal carcinomatosis was significantly associated with poorer prognosis, with survival at 5 years of 13.95% (95 %CI 2.9-33.6) vs. 43.87% (22.2-63.7) when no metastases were present (P= 0.018). Median PFS was 9.5 months (95 %CI 6.2-11.1).
  
  
  CONCLUSIONS
  With an equivalent PCI range and despite one of the highest rates of LLM in the literature, our survival data of CRS + systemic chemotherapy only compare well with results reported after additional HIPEC. Tolerance was better with acceptable morbidity without any mortality. Extra-hepatic metastasis (LLM) is a strong factor of poor prognosis. Awaiting the results of the randomized PRODIGE trial, these results indicate that CRS + systemic chemotherapy only is a robust hypothesis to treat colorectal CPM.
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Désolneux
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Mazière
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Jérémy
authors.initials: J
authors.lastname: Vara
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Brouste
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Fonck
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Béchade
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Bécouarn
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, Bordeaux, France; Univ. Bordeaux, Bordeaux, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Evrard
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents
references.citation: J Clin Oncol. 2010 Jan 1;28(1):63-8
references.pmid: 19917863
references.citation: Ann Surg Oncol. 2004 May;11(5):518-21
references.pmid: 15123461
references.citation: Lancet Oncol. 2012 Nov;13(11):e462-3
references.pmid: 23117000
references.citation: J Clin Oncol. 2003 Oct 15;21(20):3737-43
references.pmid: 14551293
references.citation: Semin Oncol. 1989 Aug;16(4 Suppl 6):83-97
references.pmid: 2669141
references.citation: J Clin Oncol. 2009 Feb 10;27(5):681-5
references.pmid: 19103728
references.citation: World J Gastrointest Oncol. 2010 Feb 15;2(2):109-16
references.pmid: 21160929
references.citation: Cancer. 2000 Jun 1;88(11):2512-9
references.pmid: 10861427
references.citation: Ann Surg. 2013 Jun;257(6):1065-71
references.pmid: 23299520
references.citation: Ann Surg. 2006 Oct;244(4):632-3; author reply 633-4
references.pmid: 16998376
references.citation: Cancer Treat Res. 2007;134:425-40
references.pmid: 17633071
references.citation: Ann Surg. 2009 Jun;249(6):900-7
references.pmid: 19474692
references.citation: Int J Colorectal Dis. 2007 Nov;22(11):1295-300
references.pmid: 17458551
references.citation: Ann Surg Oncol. 2009 Oct;16(10):2744-51
references.pmid: 19626375
references.citation: J Clin Oncol. 2004 Aug 15;22(16):3284-92
references.pmid: 15310771
references.citation: Tumori. 2003 Jul-Aug;89(4 Suppl):21-3
references.pmid: 12903536
references.citation: Hepatogastroenterology. 2009 May-Jun;56(91-92):650-5
references.pmid: 19621673
references.citation: Cancer. 2010 Aug 15;116(16):3756-62
references.pmid: 20564081
references.citation: Eur J Surg Oncol. 2009 Dec;35(12):1299-305
references.pmid: 19632081
references.citation: Ann Surg Oncol. 2008 Sep;15(9):2426-32
references.pmid: 18521686
references.citation: Cancer Res. 1980 Feb;40(2):256-60
references.pmid: 6766084
references.citation: J Clin Oncol. 2011 May 20;29(15):2011-9
references.pmid: 21502544
references.citation: Ann Surg. 2004 Aug;240(2):205-13
references.pmid: 15273542
references.citation: Eur J Surg Oncol. 2006 Aug;32(6):648-54
references.pmid: 16678380
references.citation: PLoS One. 2014 Dec 08;9(12):e114404
references.pmid: 25485541
references.citation: Br J Surg. 2002 Dec;89(12):1545-50
references.pmid: 12445064
references.citation: Br J Cancer. 2004 Jan 26;90(2):403-7
references.pmid: 14735184
references.citation: Lancet Oncol. 2012 Aug;13(8):e362-9
references.pmid: 22846841
references.citation: Acta Chir Iugosl. 2006;53(2):17-21
references.pmid: 17139879
references.citation: J Clin Oncol. 2010 Jan 1;28(1):5-7
references.pmid: 19917856
references.citation: J Surg Oncol. 2008 Sep 15;98(4):263-7
references.pmid: 18726889
references.citation: Ann Surg. 2008 Nov;248(5):829-35
references.pmid: 18948811
references.citation: Ann Surg Oncol. 2007 Jan;14(1):128-33
references.pmid: 17072675
references.citation: Ann Surg Oncol. 2007 Aug;14(8):2281-8
references.pmid: 17503156
references.citation: Int J Surg Investig. 2000;1(5):431-9
references.pmid: 11341599
references.citation: Ann Surg. 2007 Apr;245(4):597-603
references.pmid: 17414609
references.citation: Surg Oncol Clin N Am. 2003 Jul;12(3):729-39, xiii
references.pmid: 14567027