Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy and Liver Resection is a Treatment Option for Patients With Peritoneal and Liver Metastases From Colorectal Cancer

Abstract

Background: Colorectal cancer frequently metastasize to the liver and peritoneum, and is associated with a poor prognosis. In selected patients, a benefit in overall survival (OS) was shown for both peritoneal metastases (PM-CRC) offered cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), and colorectal liver metastases (CLM) treated with surgical resection. However, the presence of CLM was considered a relative contraindication to CRS-HIPEC, causing a paucity in outcome data in this patient group. Study design: Patient with PM-CRC having CRS-HIPEC at a single national center between 2007 and 2023, with additional intervention for CLM, were included (previous curative treatment for extra-peritoneal and extra-hepatic metastases was allowed). Three groups were defined: CLM before CRS-HIPEC (preCRS-HIPEC); CLM resected simultaneously with CRS-HIPEC (simCRS-HIPEC); CLM after CRS-HIPEC (postCRS-HIPEC), aiming to retrospectively analyze outcomes. Results: Fifty-seven patients were included and classified as: preCRS-HIPEC (n=11), simCRS-HIPEC (n=29), and postCRS-HIPEC (n=17). Median peritoneal cancer index (PCI) was 8, 13 patients had severe complications (Clavien-Dindo ≥3), and no 90-day mortality. Median OS was 48 months after CRS-HIPEC. PCI was a predictor of OS (HR 1.11, P<0.001). We observed no difference in short or long-term outcomes between intervention groups. Discussion: This study demonstrate that patients with CLM having CRS-HIPEC had comparable OS to reports on CRS-HIPEC only, likely explained by a low PCI. Simultaneous CLM resection did not increase the risk of severe complications. Conclusion: In this national cohort, CRS-HIPEC and CLM intervention offers long-term survival, suggesting that this treatment may be offered to selected patients with PM-CRC and CLM.