Impact of Synchronous Versus Metachronous Onset of Colorectal Peritoneal Metastases on Survival Outcomes After Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Multicenter, Retrospective, Observational Study

Abstract

Background Careful selection of patients with colorectal peritoneal metastases (PM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. It remains unknown whether the time of onset of colorectal PM (synchronous vs metachronous) influences surgical morbidity and survival outcomes after CRS with HIPEC. Methods Patients with histologically proven colorectal PM who underwent CRS with HIPEC between February 2006 and December 2017 in two Dutch tertiary referral hospitals were retrospectively included from a prospectively maintained database. The onset of colorectal PM was classified as synchronous (PM diagnosed at the initiational presentation with colorectal cancer) or metachronous (PM diagnosed after initial curative colorectal resection). Major postoperative complications (Clavien–Dindo grade ≥ 3), overall survival (OS), and disease-free survival (DFS) were compared between patients with synchronous colorectal PM and those with metachronous colorectal PM using Kaplan–Meier analyses, proportional hazard analyses, and a multivariate Cox regression analysis. Results The study enrolled 433 patients, of whom 231 (53%) had synchronous colorectal PM and 202 (47%) had metachronous colorectal PM. The major postoperative complication rate and median OS were similar between the patients with synchronous colorectal PM and those with metachronous colorectal PM (26.8% vs 29.7%; p = 0.693 and 34 vs 33 months, respectively; p = 0.819). The median DFS was significantly decreased for the patients with metachronous colorectal PM and those with synchronous colorectal PM (11 vs 15 months; adjusted hazard ratio, 1.63; 95% confidence interval, 1.18–2.26). Conclusions Metachronous onset of colorectal PM is associated with early recurrence after CRS with HIPEC compared with synchronous colorectal PM, without a difference in OS or major postoperative complications. Time to onset of colorectal PM should be taken into consideration to optimize patient selection for this major procedure. Electronic supplementary material The online version of this article (10.1245/s10434-019-07294-y) contains supplementary material, which is available to authorized users.

Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

“…PCI score and completeness of cytoreduction are two of the most important, and reproducibly shown, prognostic factors associated with outcomes of patients undergoing CRS ± HIPEC [7,14]. The finding that synchronous disease was also associated with improved OS is interesting and mirrors that of a recent study in which patients with metachronous disease experienced worse RFS [32]. Of note, the current study excluded patients with extraperitoneal disease as the role of systemic therapy is more established in these patients.…”

The importance of synchronicity in the management of colorectal peritoneal metastases with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…Unlike hepatic, pulmonary and para-aortic lymph node metastases for which synchronous disease have been found to be associated with an aggressive biology and poorer survival [7,20,21], data for CPM is scarce. While Jayne et al reported poorer survival trends in the synchronous disease [9], a recent retrospective analysis by the Dutch group failed to prove a difference in outcomes between the two [22]. With a significantly reduced OS seen in the s-CPM group, our study further compounds the likelihood of poor tumour biology in patients who present with synchronous disease.…”

Perceptions in the management of colorectal peritoneal metastases: A bi-national survey of colorectal surgeons

“…Synchronous CRPM are seen in 4-13% of patients [39][40][41]. There are currently no guidelines to direct care in patients with incidentally found resectable [42] comparing outcomes after synchronous or metachronous management of CRPM with CRS and HIPEC demonstrated no difference in OS (34 vs. 33 months, p=0.819). Other studies have similarly demonstrated no difference in survival between metachronous and synchronous treatment of CRPM with CRS and HIPEC [43,44].…”