Safety and efficacy of combined resection of colorectal peritoneal and liver metastases

Abstract

Background To determine if a select subgroup of patients with combined liver and peritoneal colorectal metastases would derive oncologic benefit from surgical resection as a component of multimodality treatment. Materials and Methods We retrospectively compared 32 patients with combined colorectal peritoneal and liver metastases (CRLM) and 173 patients with peritoneal metastases only (CRPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC). Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting survival. Results Major postoperative complications (Clavien-Dindo grades 3–5) occurred in 32% (CRLM) and 17% (CRPM) of patients (p=0.08). After an estimated median follow-up from surgery of 57 months, propensity score adjusted median progression-free survival was 5.1 months (CRLM) and 7.6 months (CRPM), while median overall survival was 13 months (CRLM) and 21 months (CRPM). Multivariate Cox-regression analysis of the CRLM group identified number of liver metastases to be the only independent predictor of poor survival (HR 2.3, P=0.03), with a dramatic decrease in survival in patients with more than 3 liver metastases. Conclusions Simultaneous resection of colorectal liver metastases at the time of CRS-HIPEC for peritoneal metastases may be associated with worse survival, especially in patients with more than 3 liver metastases.

Clinical outcomes of complete cytoreduction with concurrent liver resection followed by hyperthermic intraperitoneal chemotherapy for synchronous peritoneal and liver metastatic colorectal cancer

“…Bile leakage occurred in only two patients (9.1%) who were treated with endoscopic biliary drainage and reoperation, respectively. These results were comparable to those in previously published studies that had major complication rates of 23.8–51.4% and mortality rates of 0–8.1% [3, 19–24]. As CRS with HIPEC has an overall morbidity rate of 23–45% and mortality rate of 0–12% in CRC patients with peritoneal metastasis only, the addition of concurrent liver resection does not seem to reduce safety [25].…”

“…Approximately 20–25% of colorectal cancer (CRC) patients are diagnosed with metastatic CR C[1]. The most common site of metastatic CRC is the liver, accounting for 30–40% of metastatic CRC cases, and the most common cause of death is liver metastasis followed by peritoneal metastasis [2, 3]. Complete resection with systemic chemotherapy is a potentially curative treatment option for patients with metastatic CRC.…”

Clinical outcomes of curative treatment for colorectal liver metastases combined with cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastases: a systematic review and meta-analysis of current evidence

“…(PCI) value and 1 study reported a lower PCI value with statistically significant differences in the PC þ LM group [17,21,23]. Three studies reported a higher percentage of patients receiving preoperative chemotherapy in the PC þ LM group [17,19,23], 2 studies reported a higher HIPEC therapy rate in the PC group [16,17], and 1 study reported a higher percentage of patients receiving postoperative chemotherapy in the PC group [19].…”

“…The full texts of the remaining 32 studies were then assessed, of which 14 were included in qualitative analysis for comparison of survival outcomes [9,10,[15][16][17][18][19][20][21][22][23][24][25][26]. Finally, 9 studies that provided sufficient data for a meta-analysis of both OS and DFS were included in a quantitative synthesis [15][16][17][18][19][20][21][22][23]. A flow diagram of the literature search procedure according to the PRISMA guidelines is shown in Figure 1.…”

“…All of the included studies had compared clinical features between the two groups before statistical analysis. None of the studies had reported significant differences in terms of age, sex, performance status, or complete cytoreduction rates between the groups, apart from 1 study that recorded a higher proportion of male patients in the PC þ LM group [21], and 1 study that did not report the completeness of cytoreduction [19]. Two studies reported a higher peritoneal carcinomatosis index Studies included in quanƟtaƟve synthesis (meta-analysis) (n = 9) Figure 1.…”