title: Impacts of low peritoneal cancer index on the survival outcomes of patient with peritoneal carcinomatosis of colorectal origin.
abstract: BACKGROUND
  The combination of cytoreductive surgery (CRS) and perioperative chemotherapy (PIC) have been proposed as an innovative technique for peritoneal carcinomatosis and is currently considered as a standard treatment for colorectal peritoneal carcinomatosis (CRPC) in selected patients. Peritoneal cancer index (PCI) has been suggested to be the most important prognostic factors for the outcomes of patients with CRPC. In this paper, we have studied patients with CRPC and a very low PCI of 5 or less and their survival outcomes.
  
  
  METHODS
  This is a retrospective study of prospectively collected data of 60 consecutive patients with CRPC and PCI ≤ 5, who underwent CRS and PIC by the same surgical team at St George hospital in Sydney, Australia between January 1996 and April 2015. Clinical outcomes of these patients were analysed.
  
  
  RESULTS
  Hospital mortality was 0%. 14 patients (23.4%) had grade III/IV morbidity. The median follow-up was 22.2 months (range = 0.1-104.2). The median survival was 80.6 months (95% confidence interval (CI) = 35.1-126.1), with an overall 1-year, 3-year, and 5-year survival rate of 96.1%, 72.6% and 54.7% respectively. Among 60 patients, 31 patients experienced the recurrence of the disease (51.7%). The median disease-free survival was 10.8 months (95% CI = 7.2-14.4).
  
  
  CONCLUSIONS
  This innovative approach combining CRS and PIC has shown encouraging outcomes and offers hope for patients with CRPC. Our results suggest that CRS and PIC can be performed safely to provide significant survival benefits for patients with low volume of disease. Early referral to specialist centre for evaluation is warranted for better survival outcomes.
authors.affiliation: St George Clinical School, University of New South Wales, New South Wales, Australia.
authors.forename: Yeqian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia; College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
authors.forename: Nayef A
authors.initials: NA
authors.lastname: Alzahrani
authors.affiliation: Department of Surgery, Ryde Hospital, North Shore Ryde Health Service, New South Wales, Australia.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.affiliation: Department of Medical Oncology, University of New South Wales, 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, St George Hospital, New South Wales, Australia. Electronic address: david.morris@unsw.edu.au.
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000368:Aged; D001315:Australia; D002277:Carcinoma / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications*; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Colorectal cancer; Peritoneal cancer index; Peritoneal carcinomatosis