title: Synchronous liver resection with cytoreductive surgery for the treatment of liver and peritoneal metastases from colon cancer: results from an Australian centre.
abstract: BACKGROUND
  Treatment of peritoneal metastases (PM) and liver metastases (LM) from colon cancer remains controversial. LM has been viewed as exclusion criterion for cytoreductive surgery (CRS) on the basis that such spread represents systemic disease. CRS and intraperitoneal chemotherapy (IPC) has gained increasing recognition as a treatment modality for selected patients with colon cancer and PM. This study analyses results of CRS and IPC for colon cancer and synchronous resection for treatment of LM and PM.
  
  
  METHODS
  Seventy-eight patients with PM/LM colon cancer were analysed. Forty-two patients with PM were treated for disease limited to the peritoneum (A), and 36 patients received treatment for both PM and LM (B). Overall survival (OS), disease-free survival (DFS), morbidity, mortality and recurrence were compared.
  
  
  RESULTS
  Median OS and DFS was 32.8 and 13.5 months. The median OS for A and B were 45.5 and 24.4 months respectively. Within B patients, 18 had a peritoneal carcinomatosis index (PCI) >7 and >3 LM and median survival of 21.8 months compared with 18 patients with PCI ≤7 and LM ≤3 with median survival of 38.4 months. Median DFS for A and B were 17.7 and 8.5 months respectively. Twenty-seven in total experienced major complications following surgery. Sixty-one patients recurred. Of A, 71.4% recurred compared with B at 86.1%.
  
  
  CONCLUSIONS
  While our study is limited, it has demonstrated encouraging evidence that long-term survival outcomes can be achieved in this small but significant number of patients treated by CRS/IPC and additional synchronous liver resection with no significant increase in morbidity when compared with CRS/IPC alone.
authors.affiliation: Department of Surgery, University of New South Wales, Sydney, New South Wales, Australia.|Department of Surgical Oncology, St George Hospital, Sydney, New South Wales, Australia.|College of Medicine, Al-Iman Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
authors.forename: Nayef
authors.initials: N
authors.lastname: Alzahrani
authors.affiliation: Department of Surgery, University of New South Wales, Sydney, New South Wales, Australia.|Department of Surgical Oncology, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Lawson
authors.initials: L
authors.lastname: Ung
authors.affiliation: Department of Surgery, University of New South Wales, Sydney, New South Wales, Australia.|Department of Surgical Oncology, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Valle
authors.affiliation: Department of Surgery, University of New South Wales, Sydney, New South Wales, Australia.|Department of Surgical Oncology, St George Hospital, Sydney, New South Wales, Australia.|Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Winston
authors.initials: W
authors.lastname: Liauw
authors.affiliation: Department of Surgery, University of New South Wales, Sydney, New South Wales, Australia.|Department of Surgical Oncology, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D059035:Perioperative Period / Q000706:statistics & numerical data; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate
keywords: PCI; colon cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy (HIPEC); liver metastasis; peritoneal metastasis