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

Birgisson, Helgi; Enblad, Malin; Artursson, Sara; Ghanipour, Lana; Cashin, Peter; Graf, Wilhelm

doi:10.1016/j.ejso.2020.07.039

Cited by 14 publications

(9 citation statements)

References 25 publications

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“… 292 , 293 , 294 , 295 For example, palliative surgery for patients with intraperitoneal metastases such as liver cancer and ovarian cancer can alleviate their symptoms and improve their quality of life. 296 , 297 …”

Section: Interventions For Tumor Metastasismentioning

confidence: 99%

Tumor metastasis: Mechanistic insights and therapeutic interventions

Liu

Yang

et al. 2021

MedComm

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Cancer metastasis is responsible for the vast majority of cancer‐related deaths worldwide. In contrast to numerous discoveries that reveal the detailed mechanisms leading to the formation of the primary tumor, the biological underpinnings of the metastatic disease remain poorly understood. Cancer metastasis is a complex process in which cancer cells escape from the primary tumor, settle, and grow at other parts of the body. Epithelial‐mesenchymal transition and anoikis resistance of tumor cells are the main forces to promote metastasis, and multiple components in the tumor microenvironment and their complicated crosstalk with cancer cells are closely involved in distant metastasis. In addition to the three cornerstones of tumor treatment, surgery, chemotherapy, and radiotherapy, novel treatment approaches including targeted therapy and immunotherapy have been established in patients with metastatic cancer. Although the cancer survival rate has been greatly improved over the years, it is still far from satisfactory. In this review, we provided an overview of the metastasis process, summarized the cellular and molecular mechanisms involved in the dissemination and distant metastasis of cancer cells, and reviewed the important advances in interventions for cancer metastasis.

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Section: Interventions For Tumor Metastasismentioning

confidence: 99%

Tumor metastasis: Mechanistic insights and therapeutic interventions

Liu

Yang

et al. 2021

MedComm

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“…On the other hand, there are a few series such as the one published by Birgisson et al. that demonstrated that despite worse OS in high PCI, there is still a survival advantage in patients undergoing CRS/HIPEC with median OS of 20 months and 7% surviving beyond 5 years 14 In our series, we demonstrated increased operative times, EBL, and increased overall complications rates; nonetheless, the rate of major complications, transfusions, reoperations, ICU and hospital LOS were similar. We have demonstrated that in an experienced, high‐volume, tertiary referral center CRS/HIPEC in the high PCI population can be accomplished with acceptable morbidity.…”

Section: Discussionmentioning

confidence: 99%

Extremely high peritoneal cancer index in colorectal peritoneal metastases demonstrates safety and overall survival benefit in selected patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

Ben‐Yaacov,

Levine,

Schtrechman

et al. 2024

World j. surg.

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BackgroundColorectal peritoneal metastases are a devastating consequence of colorectal cancer (CRC) with extremely poor prognosis. Patients that can undergo complete cytoreduction by cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) have a markedly improved overall survival. Traditionally, patients with extremely high peritoneal cancer index (PCI), PCI >20, are not offered CRS/HIPEC.MethodsWe performed a retrospective analysis of our prospectively maintained CRS/HIPEC database and evaluated all patients with CRC peritoneal metastases between 2012 and 2022. We divided the cohorts between those with low operative PCI (PCI<20) and high operative PCI (PCI =>20). We examined demographic, clinicopathologic data, perioperative, and oncological outcomes between the cohorts.ResultsOf the 691 patients who underwent CRS/HIPEC, 289 were evaluable with CRC metastases, 234 with PCI <20 and 43 with PCI => 20. Median radiologic preoperative and operative PCI was 4 and 10 versus 7 and 24.5 in the low and high PCI cohorts, respectively. Operative time was longer (6 vs. 4 h) and blood loss higher (500 vs. 400 mL) in the high PCI cohort. All other demographic, clinicopathological, and operative characteristics were similar. Median disease free survival (DFS) was longer in the low PCI cohort (11.5 vs. 7 months) but overall survival (OS) showed benefit (41.3 vs. 31.8 months), (p = 0.001 and p = 0.189, respectively), comparatively with an only chemotherapy strategy.ConclusionsAppropriately selected patients with CRC metastases and extremely high PCI demonstrate similar perioperative safety outcomes in experienced tertiary referral centers. Despite a shorter median DFS, these carefully selected patients demonstrated similar median OS.

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“… 36 It is not possible to define an absolute cut-off value above which CRS and HIPEC should not be performed, since long-term survival in selected cases with high PCI values is sometimes possible. 37 Nevertheless, global experts agree that surgical treatment should only be performed if complete macroscopic cytoreduction is achievable. 38 This general opinion is based upon the strongly diminished survival of patients with incomplete macroscopic cytoreduction.…”

Section: Extent Of Peritoneal Diseasementioning

confidence: 99%

Effective Strategies to Predict Survival of Colorectal Peritoneal Metastases Patients Eligible for Cytoreductive Surgery and HIPEC

Simkens¹,

Wintjens²,

Rovers

et al. 2021

CMAR

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Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), often combined with systemic therapy, can be offered to selected colorectal peritoneal metastases (PM) patients. However, clinical heterogeneity and the lack of high-level evidence challenges determination of the correct treatment strategy. This review aims to provide an overview of current strategies to predict survival of colorectal PM patients treated with CRS and HIPEC, guiding clinicians to select a suitable treatment-strategy and to inform patients about their prognosis. First, the prognostic relevance of several clinicopathological prognostic factors, such as extent of PM, location of primary tumor, histology type, and the presence of lymph node or liver metastases will be discussed. Subsequently, special attention will be given to recent developments in several aspects of tumor biology such as RAF/RAS mutations, circulating tumor DNA, immunoprofiling, and consensus molecular subtypes. Finally, currently available prognostic models to predict survival will be evaluated, concluding these models perform moderate to good, but most of them partly rely on intra-operative data. New insights in tumor biology, as well as the reliable assessment of extent of peritoneal disease by diffusion weighted MRI pose promising opportunities to establish an adequate and clinically meaningful preoperative prognostic model in the near future.

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

Cited by 14 publications

References 25 publications

Tumor metastasis: Mechanistic insights and therapeutic interventions

Tumor metastasis: Mechanistic insights and therapeutic interventions

Extremely high peritoneal cancer index in colorectal peritoneal metastases demonstrates safety and overall survival benefit in selected patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

Effective Strategies to Predict Survival of Colorectal Peritoneal Metastases Patients Eligible for Cytoreductive Surgery and HIPEC

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