Peritoneal carcinomatosis in colorectal cancer: Defining predictive factors for successful cytoreductive surgery and hyperthermic intraperitoneal chemotherapy – A pilot study

Mahmoud, Ahmed M.; Ismail, Yahia M.; Hussien, Alaadin; Debaky, Yasser; Ahmed, Iftekhar; Mikhael, Hisham S. Wahba; Moneer, Manar M.

doi:10.1016/j.jnci.2018.10.004

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…Similarly, the PCI and CC0 are two important prognostic factors in patients with peritoneal metastases secondary to colorectal cancer. Unlike the PCI in appendiceal cancer, PCI in colorectal cancer has a perfect linear correlation with overall survival (26)(27)(28)(29). Thus, given that second-look surgery detects disease at a lower PCI score, it may be a more accurate diagnostic therapeutic procedure and provide better outcomes in select groups of patients.…”

Section: Discussionmentioning

confidence: 99%

Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

BREAKEIT

LIU

CHENG

et al. 2022

In Vivo

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Background/Aim: Up to a third of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) of appendiceal or colorectal origin receive a stoma during primary surgery. Stoma reversal provides an opportunity for second-look surgery. Patients and Methods: We performed a retrospective analysis of prospectively collected data of patients with colorectal cancer (CRC) or high-grade appendiceal cancer (AC) from 2006 to 2021 from our database. A total of 34 consecutive stoma closure patients with no evidence of preoperative disease recurrence (tumor markers and CT scans) were compared with 141 consecutive re-do CRS/HIPEC patients with known recurrence. Results: Eleven patients (32.4%) were identified to have peritoneal recurrence at stoma closure. Time between first and second CRS was 12 months (4 to 64.2) in the stoma closure group vs. 24.6 months (5.8 to 119.8) in the re-do group, while median peritoneal cancer index (PCI) was 4 (3 to 6) vs. 8 (1 to 39), respectively (p=0.0143). Conclusion: Second-look laparotomy during stoma closure identified unexpected PC in 32.4% of our patients with significantly lower PCI than planned re-do operations.In recent decades, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for select patients with peritoneal carcinomatosis (PC) has shown improved survival rates compared to systemic chemotherapy with or without palliative surgery (1-5). One meta-analysis has shown that CRS with HIPEC offers a median survival of 29 months in patients with PC, which is significantly longer than the median survival of 17.9 months for standard chemotherapy alone (6).Despite advancements in CRS and HIPEC, peritoneal disease recurrence rates in colorectal cancer (CRC) or highgrade appendiceal cancer (AC) can be as high as 80% and 40%, respectively, within two years of surgery (7, 8). Currently, postoperative monitoring consists primarily of routine cross-sectional imaging by way of computed tomography (CT) scan, combined with serum biochemical markers to diagnose recurrence of disease (9). Patients with recurrent disease may then undergo a second CRS (hereafter, re-do CRS). However, recurrence is often difficult to detect by imaging and biochemistry alone as patients are often asymptomatic in the early stages of recurrence, and the sensitivity of CT scanning in detecting peritoneal recurrence approaches 60%, while also being influenced by factors such as size and extent of disease, location of spread, and radiologist expertise (10, 11). It has been established in the literature that the extent of peritoneal disease, as measured by the peritoneal cancer index (PCI), has a significant impact on the patient's prognosis, with a lower burden of peritoneal disease being associated with better CRS outcomes and improvements in morbidity (12). As earlier detection of disease is associated with a lower burden of peritoneal disease, better techniques should be devised to enable earlier 2350

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Section: Discussionmentioning

confidence: 99%

Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

BREAKEIT

LIU

CHENG

et al. 2022

In Vivo

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Adoption of cytoreductive surgery in the management of peritoneal malignancies—Global trends

Sedighim,

Khan,

et al. 2023

Journal of Surgical Oncology

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Cytoreductive surgery (CRS) has now been accepted as an integral component in the management of gastrointestinal and gynecological cancers with peritoneal metastases. Since the adoption of CRS is influenced by access to advanced medical facilities, trained multidisciplinary teams, and funding, there is wide variability in incorporation of CRS into routine clinical practice between high‐ versus low‐ and middle‐income countries. This review highlights the global trends in the adoption of CRS for peritoneal malignancies with a specific focus on the establishment of CRS programs and barriers to incorporate CRS into routine clinical care in low‐ and middle‐income countries.

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Distal pancreatectomy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Identifying risk and improving patient selection

Sullivan

Leigh

Bekhor

et al. 2020

The American Journal of Surgery

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Peritoneal carcinomatosis in colorectal cancer: Defining predictive factors for successful cytoreductive surgery and hyperthermic intraperitoneal chemotherapy – A pilot study

Cited by 4 publications

References 25 publications

Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Adoption of cytoreductive surgery in the management of peritoneal malignancies—Global trends

Distal pancreatectomy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Identifying risk and improving patient selection

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