title: Peritoneal carcinomatosis with synchronous liver metastases from colorectal cancer: Who will benefit from complete cytoreductive surgery?
abstract: OBJECTIVE
  Selection of patients for resection of synchronous liver metastases (LM) and peritoneal carcinomatosis (PC) of colorectal cancer (CRC) remains a debated issue since morbidity of this surgery is not negligible. We aimed to define overall survival (OS) prognostic criteria in patients undergoing PC surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and LM resection.
  
  
  METHODS
  This monocentric and comparative study included all consecutive patients operated for LM (LM group, n = 77), PC (HIPEC group, n = 18) and PC + LM (LM + HIPEC group, n = 9) from January 2007 to May 2011. Characteristics of the 3 groups were prospectively collected and retrospectively compared.
  
  
  RESULTS
  Median follow-up was 56,5 months. Major morbidity and mortality were respectively 14% and 3%. Two-year disease free and overall survival rates were respectively 23% and 76%. There were significantly more Dindo grade III-IV complications in LM + HIPEC group. In multivariate analysis, grade II and III preoperative chemotherapy-induced toxicity and size of LM were identified as poor OS prognostic factors whereas response to preoperative chemotherapy significantly increases OS. OS was not different (p = 0.235) between the 3 groups.
  
  
  CONCLUSIONS
  Toxicity to preoperative chemotherapy and size of LM were identified as poor prognostic factors in patients undergoing simultaneous PC and LM surgery. These criteria could help in better selecting patients for such extensive surgery.
authors.affiliation: Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France. Electronic address: jean-baptiste.delhorme@chru-strasbourg.fr.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Delhorme
authors.affiliation: Department of Hepato-gastro-enterology and Nutritive Assistance, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Dupont-Kazma
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.affiliation: Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
authors.forename: François
authors.initials: F
authors.lastname: Lefebvre
authors.affiliation: Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Elhocine
authors.initials: E
authors.lastname: Triki
authors.affiliation: Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Romain
authors.affiliation: Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.affiliation: Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Rohr
authors.affiliation: Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Brigand
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008113:Liver Neoplasms / Q000139:chemically induced / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents
keywords: Colorectal cancer; Cytoreductive surgery; HIPEC; Liver metastasis; Liver resection; Peritoneal carcinomatosis