Prognostic factors influencing survival in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated colorectal peritoneal metastases: a systematic review and meta‐analysis

Abstract

Aim Peritoneal metastases from colorectal cancer confer the worst survival among all metastatic sites. The adoption of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can offer selected patients with isolated colorectal peritoneal metastases (CRPM) a favourable long-term survival. There are numerous factors postulated to influence survival in patients undergoing CRS and HIPEC. The aim of this study was to identify the key perioperative prognostic factors that influence survival in patients undergoing CRS and HIPEC for isolated CRPM. Method A systematic review and meta-analysis were conducted to evaluate prognostic factors influencing survival in patients undergoing CRS and HIPEC for isolated CRPM. Results Thirty-three studies fitted the inclusion criteria for the systematic review, with 25 studies included in the meta-analysis. On pooled analysis, incomplete cytoreduction, increasing peritoneal carcinoma index (PCI) and lymph node involvement were significantly associated with a worse survival. Additionally, a rectal primary [hazard ratio (HR) 1.93, 95% CI 1.10-3.37], adjuvant chemotherapy (HR 0.71, 95% CI 0.54-0.93) and perioperative grade III/IV morbidity (HR 1.59, 95% CI 1.17-2.16) were also found to significantly influence survival. Notably, tumour differentiation and signet ring cell histology did not influence survival on pooled analysis. Conclusion This meta-analysis confirms that in patients undergoing CRS and HIPEC for isolated CRPM, incomplete cytoreduction, high PCI and lymph node involvement have a negative influence on survival. In addition, a rectal primary, adjuvant chemotherapy use and grade III/IV morbidity are important factors that also significantly influence survival.

Can Elderly Patients with Peritoneal Metastasis Induced by Appendiceal or Colorectal Tumours Benefit from Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

“…Therefore, this complex procedure has received much attention, mostly concerning patient morbidity and mortality due to its invasive nature. [10][11][12] Furthermore, for most elderly patients with underlying diseases, the incidence of cardiovascular and respiratory complications during the perioperative period is relatively high. The development of major postoperative complications will lead to poor prognosis and even death.…”

Pelvic exenteration combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced primary or recurrent colorectal cancer with peritoneal metastases

“…Although results from this initial experience indicate that combined PE with CRS and HIPEC is technically feasible and safe in the short term, such extensive and prolonged procedures can be associated with significant morbidity, with 50% of patients in this study developing at least one major postoperative complication. This risk of morbidity following combined surgery is expectedly higher than the reported rate of major (Grade III/IV) complications following CRS and HIPEC for CPM (13%–42%) [28] and following PE for locally advanced rectal cancer and locally recurrent rectal cancer (38% and 32%, respectively) [2,5]. Appropriate patient selection is crucial and this technique should only be considered in highly selected, fit and motivated patients and at specialized units with experience in both PE and CRS and HIPEC surgery.…”

High-grade postoperative complications affect survival outcomes of patients with colorectal Cancer peritoneal metastases treated with Cytoreductive surgery and Hyperthermic Intraperitoneal chemotherapy

“…Tan et al reported that patients without complications had significantly better survival than those with high-grade complications (HR, 0.35, 95% CI, 0.15-0.81; P< 0.001) [35]. A meta-analysis study including 717 patients who underwent CRS+HIPEC conducted by Narasimha et al also showed that the presence of grade III/IV morbidity was independently associated with worse overall survival (HR, 1.59, 95% CI, 1.17-2.16; P=0.003) [36]. The above research supports our results.…”