Results of a randomized phase 3 study evaluating the potential benefit of a second-look surgery plus HIPEC in patients at high risk of developing colorectal peritoneal metastases (PROPHYLOCHIP- NTC01226394).

Goèré, Diane; Gléhen, Olivier; Quénet, François; Ducreux, Michel; Guilloit, Jean-Marc; Texier, Matthieu; Benhamou, E; Élias, Dominique

doi:10.1200/jco.2018.36.15_suppl.3531

Cited by 60 publications

(41 citation statements)

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“…In the French trial (PROPHYLOCHIP), second-look surgery is performed 6-12 months after surgery for the primary tumor. 26 In contrast, in the Dutch trial (COLOPEC), the second-look procedure is performed immediately after surgery for the primary tumor (10 days) or after an interval of 5-8 weeks. 20 In both studies, there is consensus on performing this type of intervention in patients with isolated PC and various different risk factors for the peritoneal development, such as those mentioned above, but what about pT4 tumors?…”

Section: Discussionmentioning

confidence: 99%

Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?

et al. 2019

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Background. The peritoneum is the second most common site for metastasis in patients with colorectal cancer. Various factors have been studied to identify patients at risk of developing peritoneal carcinomatosis (PC), including T4 tumors. The objectives were to assess the incidence of synchronous and metachronous PC, explore potential risk factors for developing PC as the only site of metastasis, and identify which patients might be candidates for prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC). Methods. We conducted a retrospective analysis of 125 patients with pT4 colon cancer who underwent surgery in a single center between January 2010 and December 2014. Results. Of the 947 colon cancer patients who underwent surgery, 125 (13.2%) were diagnosed with pT4a or b colon carcinoma. The median follow-up was 3.7 years. The overall rate of PC was 34.3%, being synchronous in 12% and metachronous in 22.3% of cases. The 8% and 6% of synchronous and metachronous cases of PC respectively were isolated (single site) metastasis. The incidence of PC was 6.1% at 1 year and 14.5% at 3 years after surgery. pT4 was not found to be an independent risk factor for the development of PC (p = 0.231). Nonetheless, the rate of metachronous PC as a single site of metastasis was higher in patients with pT4 tumors and peritoneal nodules around the primary tumor and/or tumor perforation (p = 0.027) and/or who underwent emergency surgery (p = 0.043) than other patients.

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Section: Discussionmentioning

confidence: 99%

Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?

et al. 2019

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“…Recent RCTs however, offer a different view. The recently completed French RCT (Prophylochip-NCT01226394) [32] explored the role of systematic second-look surgery and oxaliplatin based HIPEC vs. surveillance for asymptomatic patients 6 months following a high risk primary colorectal cancer resection. High risk was defined as minimal CRPM resected with the primary, ovarian metastases or perforated primary tumour.…”

Section: Discussionmentioning

confidence: 99%

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

Narasimhan

Warrier

Michael

et al. 2019

Pleura and Peritoneum

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BackgroundThere is great variability in the uptake of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of colorectal peritoneal metastases (CRPM) in Australia and New Zealand. This study aims to provide a snapshot of perceptions among colorectal surgeons in the management of CRPM.MethodsA structured ten-question online survey was sent to all colorectal surgeons, with three questions on clinical experience and demographics, one on health economics and six on hypothetical clinical scenarios. Scores were collated and reported based on Likert scales.ResultsEighty-one respondents (36.2%) completed the survey. Most surgeons (66.7%) strongly disagreed with offering CRS and HIPEC at all hospitals. The majority (87.7%) agreed that CRS and HIPEC offered a higher survival benefit than systemic chemotherapy in pseudomyxoma peritonei (PMP), and 69.1% in CRPM (comparators: 60.5% ovarian cancer, 14.8% gastric cancer). There were mixed strategies in managing low-volume, isolated peritoneal recurrences. The majority did not recommend second-look laparoscopy, but favoured operative management of Krukenberg tumours. In the presence of incidental peritoneal metastases, only 29.6% favoured biopsy only and referring the patient to a peritoneal disease centre.ConclusionsResponse rate was relatively low. In Australia and New Zealand, colorectal surgeons see a strong role for CRS and HIPEC in the management of PMP and CRPM. The role of “second look” surgery in high-risk cases is controversial and not supported. Krukenberg tumours are viewed as surgical disease. Regular updates and collaboration with peritoneal centres may help surgeons stay abreast with latest evidence in the field.

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“…Many HIPEC centers, including our own, now routinely perform DLS, not just to document the extent of disease but also to screen patients at high risk for peritoneal recurrence. The added value of DLS is the subject of the COLOPEC II trial 5 and can be inferred from the high rate of recurrent disease identified in the PRO-PHYLOCHIP trial, 6 in which 52% of patients had peritoneal disease at the time of second-look surgery. Concerns regarding the safety of DLS in this patient population, given the high rate of prior surgery and the potential risk of port-site metastases, have not been confirmed.…”

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confidence: 99%

Comment on “Diagnostic Laparoscopy as a Selection Tool for Patients with Colorectal Peritoneal Metastases to Prevent a Non-therapeutic Laparotomy During Cytoreductive Surgery”

Pameijer

2020

Ann Surg Oncol

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Results of a randomized phase 3 study evaluating the potential benefit of a second-look surgery plus HIPEC in patients at high risk of developing colorectal peritoneal metastases (PROPHYLOCHIP- NTC01226394).

Cited by 60 publications

References 0 publications

Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?

Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?

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

Comment on “Diagnostic Laparoscopy as a Selection Tool for Patients with Colorectal Peritoneal Metastases to Prevent a Non-therapeutic Laparotomy During Cytoreductive Surgery”

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