Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy improves survival in patients with colorectal peritoneal metastases compared with systemic chemotherapy alone

Abstract

Background:Colorectal cancer peritoneal metastasis (CPM) confers an exceptionally poor prognosis, and traditional treatment involving systemic chemotherapy (SC) is largely ineffective. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly advocated for selected patients with CPM; however, opinions are divided because of the perceived lack of evidence, high morbidity, mortality, and associated costs for this approach. As there is no clear consensus, the aim of this study was to compare outcomes following CRS+HIPEC vs SC alone for CPM using meta-analytical methodology, focusing on survival outcomes. Secondary outcomes assessed included morbidity, mortality, quality of life (QOL), and health economics (HE).Methods:An electronic literature search was conducted to identify studies comparing survival following CRS+HIPEC vs SC for CPM. The odds ratio (OR) was calculated using the Mantel–Haenszel method with corresponding 95% confidence intervals (CI) and P-values. Heterogeneity was examined using the Q-statistic and quantified with I2. The fixed-effect model (FEM) was used in the absence of significant heterogeneity. For included studies, 2- and 5-year survival was compared for CRS+HIPEC vs SC alone.Results:Four studies (three case–control, one RCT) provided comparative survival data for patients undergoing CRS+HIPEC (n=187) vs SC (n=155) for CPM. Pooled analysis demonstrated superior 2-year (OR 2.78; 95% CI 1.72–4.51; P=0.001) and 5-year (OR 4.07; 95% CI 2.17–7.64; P=0.001) survival with CRS+HIPEC compared with SC. Mortality ranged from 0 to 8%. No data were available for the assessment of QOL or HE.Conclusions:Although limited by between-study heterogeneity, the data support the assertion that in carefully selected patients, multimodal treatment of CPM with CRS+HIPEC has a highly positive prognostic impact on medium- and long-term survival compared with SC alone. There is a paucity of comparative data available on morbidity, QOL, and HE.

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

“…Regarding the effectiveness of CRS/HIPEC, a pooled analysis was recently performed to synthesize the results of the small number of studies that compared CRS/HIPEC with systemic chemotherapy only [36]. Regarding the effectiveness of CRS/HIPEC, a pooled analysis was recently performed to synthesize the results of the small number of studies that compared CRS/HIPEC with systemic chemotherapy only [36].…”

Prospective Quality of Life Study for Colorectal Cancer Patients with Peritoneal Carcinomatosis Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

“…The median overall survival ranges from 32 to 62.7 months, whereas the 5-year overall survival ranges from 19 to 58 %. 4,5 Initial concerns about the morbidity and mortality of the procedure have been allayed. A systemic review of this procedure showed a mortality of 5.8 % and morbidity of 52 %, which were comparable to other major surgeries.…”

Treatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives

“…The most recent meta-analysis of three case-control studies and a single randomized trial suggested that survival was significantly improved after crs, hipec, and systemic chemotherapy compared with systemic chemotherapy alone 68 . A pooled analysis demonstrated superior 2-year (odds ratio: 2.78; p = 0.001) and 5-year survival (odds ratio: 4.07; p = 0.001) with crs and hipec (n = 187) than with systemic chemotherapy alone (n = 155).…”