Thirty-three long-term survivors after cytoreductive surgery in patients with peritoneal metastases from colorectal cancer: a retrospective descriptive study

Abstract

Background Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in selected patients with peritoneal metastasis (PM) from colorectal cancer (CRC). However, little has been reported on characteristics and clinical course of long-term survivors with CRC-PM beyond 5 years. The objective of this study was to identify the clinical and oncological features affecting long-term survival of CRC-PM after comprehensive treatment. Methods Between January 1990 and April 2015, CRC-PM patients who underwent CRS with or without HIPEC in two Japanese tertiary hospitals were analyzed. Clinicopathological parameters and therapeutic details for long-term survivors (patients surviving ≥ 5 years after CRS) were described and compared with those for non-survivors (patients surviving < 5 years). Results The study identified 236 patients with CRC-PM who underwent CRS, with a median follow-up period of 2.5 years. Thirty-three patients (14.0%) were considered as long-term survivors. Compared with non-survivors, long-term survivors had a lower median peritoneal cancer index (PCI) [4 (1–27) vs 9 (0–39), p < 0.001]. Complete cytoreduction (CCR-0) was achieved in all long-term survivors, with a significantly higher rate [33/33 (100%) vs 141/203 (69.8%), p < 0.001]. Metachronous onsets of PM were more frequently observed in the long-term survivor group [26/33 (78.8%) vs 103/203 (50.3%), p = 0.018]. Regarding histopathology, long-term survivors more frequently had mucinous adenocarcinoma than non-survivors [8/33 (24.2%) vs 27/203 (13.3%)] and less likely exhibited poorly differentiated or signet ring cell carcinoma [2/33 (6.1%) vs 48/203 (23.7%)] (p < 0.001). Conclusions One in seven patients with CRC-PM achieved the long-term milestone after CRS. A long-term survival was associated with the presence of low PCI, CCR-0, metachronous onset, and mucinous histology.

The Characteristics of 206 Long-Term Survivors with Peritoneal Metastases from Colorectal Cancer Treated with Curative Intent Surgery: A Multi-Center Cohort from PSOGI

“…Of note, more than half (63.1%, 130/206) of the patients showed an SB-PCI = 0. In our previous study [32], the median SB-PCI for the entire cohort was 2 (IQR, 0-3). Between this present study and the previous one, the SB-PCI cannot be statistically compared, but these findings suggest that lower SB-PCIs than that of other abdominopelvic regions are needed for long-term survival.…”

“…Also, about 90% of the long-term survivors and cured patients (180/206, 87.4%, and 77/84, 91.7%) achieved CC-0. The previous study [32] demonstrated that there was a statistically significant difference in CC-0 rates between long-term survivors and non-survivors (33/33 (100%) versus 141/203 (69.8%), p < 0.001). As such, these data indicate that low PCI and CC-0 are associated with long-term survival and cure in patients with peritoneal metastases from CRC, although a statistical comparison should not be conducted because of the different datasets.…”

“…Most of the patients in our cohort (169/206, 82.0%) exhibited a PCI ≤ 10 for a median of 4 (IQR, 2-7). Our recently published study, which used data on patients with peritoneal metastases from CRC in two Japanese hospitals, compared the characteristics of long-term survivors with those of non-survivors (OS < 5 years) [32]. The previous study showed that the median PCI was significantly lower in long-term survivors (4 (range, 1-27) versus 9 (range, 0-39), p < 0.001), and the cohort showed the following results: the 5-year survival rate was 14.0%; the median PCI was 8 (IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; the distribution of the PCI was 0 to 5 in 86 patients, 6 to 10 in 50, 11 to 15 in 27, 16 to 20 in 21, and ≥21 in 52.…”

Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low- and middle-income countries: a single-center experience of 232 cases

“…First is the disease type, and the other is the extent and volume of peritoneal spread. Based on current literature pseudomyxoma peritonei, mesothelioma, peritoneal metastases of tumors of appendicular and colorectal origin, and ovarian cancers have shown benefit with CRS and HIPEC [15][16][17][18][19][20][21][22]. CT scan of the abdomen and pelvis is used to assess volume and extent of peritoneal spread and helps to determine feasibility of optimal cytoreduction.…”

Postoperative oxaliplatin-based hyperthermic intraperitoneal chemotherapy: an effective and safe palliative treatment option for colorectal cancer with peritoneal metastasis

“…Indeed, recent trials reported no benefits in terms of survival [ 20 , 22 , 23 ]. In addition, a study suggested that one patient over seven who undergo CRS achieves long-term survival [ 24 ]. In addition, due to the extent of the disease and the surgeon’s experience and skills, not all patients can undergo complete/satisfactory CRS.…”