Complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastasis in Norway: Prognostic factors and oncologic outcome in a national patient cohort

Frøysnes, Ida Storhaug; Larsen, Stein Gunnar; Spasojevic, Milan; Dueland, Svein; Flatmark, Kjersti

doi:10.1002/jso.24290

Cited by 55 publications

(60 citation statements)

References 37 publications

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“…In 15 of the guidelines included in this review, CRS/ HIPEC was recommended in selected patients as a curative intent treatment option for PMCRC (1)(2)(3)5,7,8,10,11,(13)(14)(15)(16)(19)(20)(21), but owing to the significant risks of morbidity and mortality the Belgian and English guidelines (2,3) recommend special arrangements for consent and appropriate clinical governance, including audit. The American Society of Colon and Rectal Surgeons (ASCRS) (18) did recommend cytoreductive surgery for PMCRC, but considered the role of HIPEC as insufficiently defined.…”

Section: Crs/hipec As Treatment Option For Pmcrc?mentioning

confidence: 99%

“…Although not based on evidence, multidisciplinary team (MDT) discussion was recommended in 15 of the 21 guidelines (1)(2)(3)(4)(5)(6)(7)(8)10,12,13,16,(18)(19)(20). In two guidelines, the required members of the MDT were listed.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

“…The effect of palliative chemotherapy is limited, even for modern chemotherapy regimens with or without targeted agents [5,6]. More recent national cohorts in selected patients receiving CRS/HIPEC show median survival rates up to 33 and 47 months [9,10]. Verwaal et al performed a randomized controlled trial (RCT) [7] showing that CRS/HIPEC prolongs median survival for up to 22 months in selected patients compared with 13 months following systemic therapy only.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, the only curative intent treatment option is the combination of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) [7,8]. Also, CRS/HIPEC is accompanied by substantial morbidity [9][10][11]. More recent national cohorts in selected patients receiving CRS/HIPEC show median survival rates up to 33 and 47 months [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines

et al. 2017

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Section: Crs/hipec As Treatment Option For Pmcrc?mentioning

confidence: 99%

Section: Preoperative Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines

et al. 2017

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“…A much higher PCI is in general accepted for PMP patients, as CRS-HIPEC is shown to be beneficial with higher PCI in PMP patients than in those with PM-CRC. PCI seems to be the most important predictor of survival in PM-CRC [18, 19], while PCI as a predictor in PMP is disputed. Some authors have not found correlation with survival even in peritoneal dissemination from high-grade appendiceal primaries [20], while others have found high PCI as a predictor for poorer progression-free survival (PFS) [21].…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report

et al. 2018

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BackgroundDiagnostic work-ups in transplanted immunosuppressed patients are a challenge as non-specific findings may be interpreted as transplant-related complications. If the disease in question is rare and slowly developing like pseudomyxoma peritonei (PMP), it is even more difficult. Cytoreductive surgery (CRS) and subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is the recommended treatment for PMP even with extensive peritoneal spread. CRS-HIPEC for PMP after liver transplantation (LTX) has not been described before.Case presentationA 48-year-old female patient with end-stage primary sclerosing cholangitis (PSC) underwent orthotopic LTX and subsequent pancreaticoduodenectomy after the finding of cholangiocarcinoma in situ in the native common bile duct. Ten years after the transplantation, she developed symptoms and signs suspected to represent graft-related complications. An extensive work-up revealed PMP. Upon reassessment, a cystic mass near the coecum could be seen on computed tomography scan 1 year after transplantation. The multidisiplinary team was hesitant to accept the patient for CRS-HIPEC because of extensive PMP and possible risk to the graft. However, she was eventually accepted and underwent the procedure. The Peritoneal Cancer Index (PCI) was 28 of 39, and surgical debulking was performed followed by HIPEC. The transplant control 2 months after surgery showed no harm to the graft.ConclusionsPrevious LTX should not exclude the possibility for CRS-HIPEC in PMP, even with extensive burden of disease.

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Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Sant

Eden

Engbersen

et al. 2019

Journal of British Surgery

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Background: Patients with limited peritoneal metastases from colorectal cancer may be candidates for an aggressive surgical approach including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Selection is based on surgical inspection during laparoscopy or laparotomy. The aim of this study was to investigate whether diffusion-weighted MRI (DW-MRI) can be used to select patients for CRS-HIPEC.Methods: This was a prospective study at a tertiary referral centre. Patients with confirmed or suspected colorectal peritoneal metastases scheduled for exploratory laparotomy or laparoscopy were eligible. Two radiologists assessed the peritoneal cancer index (PCI) on CT (CT-PCI) and DW-MRI (MRI-PCI). The reference standard was PCI at surgery. Radiologists were blinded to the surgical PCI and to each other's findings. The main outcome was the accuracy of DW-MRI in predicting whether patients had resectable disease (PCI less than 21) or not.Results: Fifty-six patients were included in the study, of whom 49 could be evaluated. The mean(s.d.) PCI at surgery was 11⋅27(7⋅53). The mean MRI-PCI was 10⋅18(7⋅07) for reader 1 and 8⋅59(7⋅08) for reader 2. Readers 1 and 2 correctly staged 47 of 49 and 44 of 49 patients respectively (accuracy 96 and 90 per cent). Both readers detected all patients with resectable disease with a PCI below 21 at surgery (sensitivity 100 per cent). No patient was overstaged. The intraclass correlation (ICC) between readers was excellent (ICC 0⋅91, 95 per cent c.i. 0⋅77 to 0⋅96). MRI-PCI had a stronger correlation with surgical PCI (ICC 0⋅83-0⋅88) than did CT-PCI (ICC 0⋅39-0⋅44).Conclusion: DW-MRI is a promising non-invasive tool to guide treatment selection in patients with peritoneal metastases from colorectal cancer.

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Complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastasis in Norway: Prognostic factors and oncologic outcome in a national patient cohort

Cited by 55 publications

References 37 publications

Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines

Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

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