Should we exclude patients with peritoneal carcinosis of colorectal origin and high PCI from CRS + HIPEC?

Fugazzola, Paola; Moroni, Alessandro; Agnoletti, Vanni; Catena, Fausto; Cobianchi, Lorenzo; Corallo, Salvatore; Mas, Francesca Dal; Frassini, Simone; Maestri, Marcello; Magnone, Stefano; Pagani, A; Pedrazzoli, Paolo; Rigamonti, Andrea; Santandrea, Giorgia; Tomasoni, Matteo; Vallicelli, Carlo; Viganò, Jacopo; Ansaloni, Luca

doi:10.1007/s13304-023-01579-4

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…This is nicely demonstrated in a study of 15 patients with High Volume disease – which they defined as PCI ≥ 16 – where CRS and HIPEC successfully achieved 2-year peritoneal disease-free survival comparable to Low Volume patients. They also report a median survival of 14 months in their High Volume group [ 29 ]. More recently, a study evaluating CRS and HIPEC in 43 patients with extremely High Volume (PCI ≥ 20) concluded that it was to achieve similar survival to their Low Volume counterparts [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery

Sarofim,

Wijayawardana,

Ahmadi

et al. 2024

World J Surg Onc

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Background Colorectal peritoneal metastases (CRPM) affects 15% of patients at initial colorectal cancer diagnosis. Neoadjuvant chemotherapy (NAC) prior to cytoreductive surgery (CRS) has been demonstrated to be a safe and feasible option, however there is limited data describing its efficacy in advanced peritoneal disease. This study evaluated the effect of NAC on survival in patients with high volume CRPM undergoing CRS with or without HIPEC. Methods A retrospective review of all patients who underwent CRS with or without HIPEC for CRPM from 2004 to 2019 at our institution was performed. The cohort was divided based on peritoneal carcinomatosis index (PCI) at surgery: Low Volume (PCI ≤ 16) and High Volume (PCI > 16). Results A total of 326 patients underwent CRS with HIPEC for CRPM. There were 39 patients (12%) with High Volume disease, and 15 of these (38%) received NAC. Patients with High Volume disease had significantly longer operating time, lower likelihood of complete macroscopic cytoreduction (CC-0 score), longer intensive care unit length of stay and longer hospital stay compared to Low Volume disease. In High Volume disease, the NAC group had a significantly shorter median survival of 14.4 months compared to 23.8 months in the non-NAC group (p = 0.046). Conclusion Patients with High Volume CRPM achieved good median survival following CRS with HIPEC, which challenges the current PCI threshold for offering CRS. The use of NAC in this cohort did not increase perioperative morbidity but was associated with significantly shorter median survival compared to upfront surgery.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery

Sarofim,

Wijayawardana,

Ahmadi

et al. 2024

World J Surg Onc

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The Importance of Preoperative NLR, PLR, and MPV Values in Predicting the Risk of Complications in Colorectal Peritoneal Carcinomatosis

Özcan,

Düzgün

2024

JPM

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Background: Colorectal cancer peritoneal carcinomatosis (CRC PC) necessitates preoperative assessment of inflammatory markers to predict postoperative outcomes and guide treatment. This study aims to evaluate the prognostic value of preoperative Neutrophil–Lymphocyte Ratio (NLR), Platelet–Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) in predicting complications for CRC PC patients undergoing surgery. Methods: Calculating NLR, PLR, and MPV from patient data: NLR = absolute neutrophil count/total lymphocyte count, PLR = total lymphocyte count/total platelet count × 100, and MPV = platelet crit (PCT)/total platelet count. Result: The study included 196 CRC PC patients and found significant relationships between these markers and overall survival (OS). Patients with an NLR of 3.77 had a median OS of 22.1 months, compared to 58.3 months for those with lower NLR (HR 2.7, 95% CI 1.1–5.3, p < 0.001). Conclusions: For CRC PC patients undergoing CRS+HIPEC, preoperative assessment of NLR, PLR, and MPV can serve as independent prognostic markers for OS. Incorporating these markers into preoperative evaluations may improve patient selection and outcome prediction.

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Should we exclude patients with peritoneal carcinosis of colorectal origin and high PCI from CRS + HIPEC?

Cited by 2 publications

References 20 publications

Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery

Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery

The Importance of Preoperative NLR, PLR, and MPV Values in Predicting the Risk of Complications in Colorectal Peritoneal Carcinomatosis

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