CRS and HIPEC in patients with peritoneal metastasis secondary to colorectal cancer: The small-bowel PCI score as a predictor of survival

Abstract

BackgroundCombining cytoreductive surgery (CRS) with Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer. The present study evaluates the small bowel subset of the Peritoneal Cancer Index (Small-Bowel-PCI score (SB-PCI), min-max 0–12) as a prognostic factor in such patients.MethodsWe retrospectively analyzed patients that underwent CRS and HIPEC for recurrent colorectal cancer with peritoneal metastasis. Patient characteristics, procedure details, and clinical outcomes were evaluated.ResultsEighty patients were included. The mean intraoperative PCI-score was 16.8, with a mean SB-PCI score of 5.9. CC0/1 was achieved in 62/80 patients. The mean follow-up period was 26.3 months. Univariate regression analysis showed that the ECOG status, the presence of severe complications, the HIPEC regimen (oxaliplatin vs. mitomycin-C), the PCI score, the SB-PCI score and the completeness of cytoreduction correlated significantly with overall survival. In multivariate analysis, the SB-PCI and CC score were identified as independent prognostic factors of survival. When the SB-PCI was stratified in three groups (0–4, 5–8 and 9–12), Kaplan–Meier curve analysis showed significant difference in survival (p<0.001).ConclusionsThe SB-PCI correlates with overall survival in patients with peritoneal metastases secondary to colorectal cancer in this retrospective cohort. Its use should be validated in prospective patient series.

Diagnostic value of diffusion-weighted imaging/magnetic resonance imaging for peritoneal metastasis from malignant tumor

“…[ 5 – 7 ] This is especially important for small lesions that are difficult to detect by CT, conventional MRI, and PET-CT. [ 9 ] Patients detected with PMs might benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. [ 26 , 27 ] The present meta-analysis revealed that DWI had 89% pooled sensitivity (95% CI: 83%–93%) and 86% pooled specificity (95% CI: 79%–91%) for the diagnosis of PMs from various abdominal cancers.…”

Patients with colorectal peritoneal metastases and high peritoneal cancer index may benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…Small bowel engagement was the most common cause for openclose/debulking operations as patients with less than 2 m of small bowel left will have a poor quality of life together with short survival. An attempt to use the PCI score only for the small bowel for prognostic estimates have recently been made revealing the importance of the small bowel involvement [4].…”

“…The knowledge on which patients should be operated on is still evolving. Patients with inoperable metastases in other organs than peritoneum [3], widespread disease on the small bowel [4] or physical poor performance [5] are generally not offered surgical treatment.…”

Exosomal miR-193a and let-7g accelerate cancer progression on primary colorectal cancer and paired peritoneal metastatic cancer

“…There is a treatment that can be performed in patients with selective conditions at a high medical level and environment. Hyperthermic intraperitoneal chemotherapy (HIPEC) is performed simultaneously following cytoreductive surgery, which suppresses the progression of peritoneal metastasis [10] , [11] , [12] , [13] . However, this treatment is known to have a high risk of mortality.…”