Surgical Treatment of Colorectal Cancer with Peritoneal and Liver Metastases Using Combined Liver and Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Report from a Single-Centre Experience

Abstract

Simultaneous surgery for colorectal LM and PC is both feasible and safe, with low postoperative morbidity. Further longer-term studies would help determine its impact on patient survival.

Clinical outcomes of curative treatment for colorectal liver metastases combined with cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastases: a systematic review and meta-analysis of current evidence

“…The full texts of the remaining 32 studies were then assessed, of which 14 were included in qualitative analysis for comparison of survival outcomes [9,10,[15][16][17][18][19][20][21][22][23][24][25][26]. Finally, 9 studies that provided sufficient data for a meta-analysis of both OS and DFS were included in a quantitative synthesis [15][16][17][18][19][20][21][22][23]. A flow diagram of the literature search procedure according to the PRISMA guidelines is shown in Figure 1.…”

Treatment of liver metastases in patients selected for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis

“…Patients selected for CS + HIPEC + LR presented with limited liver disease, as suggested by the median number of nodules (in general between 1 and 2), the rare occurrence of major resection and the frequent use of ablative techniques (cryotherapy, radiofrequency) [20,[29][30][31][32] [ Table 1 and Figure 1]. On the other hand, peritoneal load probably reflects the same tumor diffusion of patients selected for CS + HIPEC only, where a PCI index less than 20 is considered by the majority of referral centers as the preoperative cut-off value in selecting patients for treatment.…”

“…In the same way, the mortality rates for liver resection, which was traditionally considered as one of the surgical procedures with the highest risk of death, have been lowered even more: for instance, recent series reported mortality rates less than 2%, comparable to those observed after surgery for rectal cancer [34,35] . CS + HIPEC + LR does not seem to give an additional risk of complication as the morbidity and mortality seems similar with respect to CS + HIPEC alone [20,[29][30][31][32] [ Table 2]. No study has reported a clear distinction between complication/mortality rate related to the liver resection or to the cytoreductive surgery.…”

“…In retrospective studies investigating the role of CS + HIPEC + LR, the procedure resulted in a median survival between 15 and 23 months, a little worse with respect to the one reported for CS + HIPEC alone [20,[29][30][31][32] . Also, in a comparative retrospective analysis of single centers, the 2-year overall survival seems lower when liver metastases are treated at the time of CS + HIPEC, ranging 43.3-89.5% for CS + HIPEC alone, and 26.8-70.2% for CS + HIPEC combined with LR [30][31][32] [ Table 2].…”

“…Also, in a comparative retrospective analysis of single centers, the 2-year overall survival seems lower when liver metastases are treated at the time of CS + HIPEC, ranging 43.3-89.5% for CS + HIPEC alone, and 26.8-70.2% for CS + HIPEC combined with LR [30][31][32] [ Table 2]. However, in the most relevant comparative study, no significant difference is detected between the treated groups [20] .…”