title: Surgical Management of Metastatic Colorectal Cancer: A Single-Centre Experience on Oncological Outcomes of Pulmonary Resection vs Cytoreductive Surgery and HIPEC.
abstract: OBJECTIVE
  Metastasectomy is accepted as standard of care for selected patients with colorectal pulmonary metastases (CLM); however, the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM) is not universally accepted. We aim to compare oncological outcomes of patients with CLM and CPM after pulmonary resection and CRS-HIPEC, respectively, by comparing overall survival (OS) and disease-free survival (DFS).
  
  
  METHODS
  A retrospective review of 49 CLM patients who underwent pulmonary resection, and 52 CPM patients who underwent CRS-HIPEC in a single institution from January 2003 to March 2015, was performed.
  
  
  RESULTS
  The 5-year OS for CLM patients and CPM patients were 59.6 and 40.5%, respectively (p = 0.100), while the 5-year DFS were 24.0 and 14.2%, respectively (p = 0.173). CPM patients had longer median operative time (8.38 vs. 1.75 h, p < 0.001), median hospital stay (13 vs. 5 days, p < 0.001), a higher rate of intensive care unit (ICU) admissions (67.3 vs. 8.2%, p < 0.001), and a higher rate of high-grade complications (17.3 vs. 4.1%, p < 0.001). Multivariate analysis demonstrated that recurrent lung metastasis after metastasectomy was an independent prognostic factor for OS of CLM patients (OR = 0.045, 95%, CL 0.003-0.622, p = 0.021). There were no independent prognostic factors for OS in CPM patients by multivariate analysis. There were no independent prognostic factors for DFS in CLM patients by multivariate analysis, but peritoneal cancer index score, bladder involvement, and higher nodal stage at presentation of the initial malignancy were independent prognostic factors for DFS in CPM patients.
  
  
  CONCLUSIONS
  OS and DFS for CPM patients after CRS and HIPEC are comparable to CLM patients after lung resection, although morbidity appears higher. The prognostic factors affecting survival after surgery are different between CPM and CLM patients and must be considered when selecting patients for metastasectomy.
authors.affiliation: Divison of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
authors.forename: Evelyn Yi Ting
authors.initials: EYT
authors.lastname: Wong
authors.affiliation: Divison of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
authors.forename: Grace Hwei Ching
authors.initials: GHC
authors.lastname: Tan
authors.affiliation: Divison of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
authors.forename: Deanna Wan Jie
authors.initials: DWJ
authors.lastname: Ng
authors.affiliation: Divison of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
authors.forename: Tina Puay Theng
authors.initials: TPT
authors.lastname: Koh
authors.affiliation: Divison of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
authors.forename: Mrinal
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Divison of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore. melissa.teo.c.c@nccs.com.sg.
authors.forename: Melissa Ching Ching
authors.initials: MCC
authors.lastname: Teo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010534:Peritoneal Neoplasms / Q000556:secondary*; D055815:Young Adult
keywords: Colorectal cancer; HIPEC; Peritoneal metastasis; Pulmonary metastasis; Survival outcomes