Should a History of Extraperitoneal Disease Be a Contraindication to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Metastases?

Dario Baratti, Shigeki Kusamura, Domenico Iusco, Christian Cotsoglou, Marcello Guaglio, Luigi Battaglia, Salvatore Virzì, Vincenzo Mazzaferro, Marcello Deraco

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Survival improvements have been reported in selected patients affected by colorectal peritoneal metastases who were undergoing cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. Treatment of peritoneal metastases associated with extraperitoneal disease is still controversial.

OBJECTIVE: We assessed the prognostic impact of a history of extraperitoneal disease that was curatively treated either at the same time as or before the onset of peritoneal metastases.

DESIGN: We reviewed 2 prospective databases. Peritoneal involvement was scored by Peritoneal Cancer Index.

SETTINGS: Our study was conducted in 2 high-volume peritoneal malignancy management institutions.

PATIENTS: A total of 148 patients with peritoneal metastases were included. In 27 patients, extraperitoneal disease involving the liver (n = 23), lung (n = 1), both lung and liver (n = 2), or inguinal lymph nodes and liver (n = 1) was curatively treated either simultaneously with peritoneal metastases (n = 22) or before their onset (n = 5).

INTERVENTIONS: All of the macroscopic tumors were removed by means of peritonectomy procedures and visceral resections. Microscopic residual disease was treated by mitomycin C/cisplatin-based hyperthermic intraperitoneal chemotherapy.

MAIN OUTCOME MEASURES: Overall survival was the primary outcome measure.

RESULTS: After a median follow-up of 34.6 months (95% CI, 22.6-65.7 mo), 5-year survival of patients treated for both peritoneal and extraperitoneal disease versus peritoneal metastases alone was 16.5% versus 52.0% (p = 0.019). After multivariate analysis, reduced survival correlated with extraperitoneal disease (p = 0.001), Peritoneal Cancer Index >19 (p = 0.004), and peritoneal residual disease >2.5 mm (p = 0.018). Three prognostic groups were defined, and median survival was not reached for group 1 (Peritoneal Cancer Index ≤19 and no extraperitoneal disease), reached in 27.0 months for group 2 (Peritoneal Cancer Index ≤9 and extraperitoneal disease), and reached in 11.6 months for group 3 (Peritoneal Cancer Index >19 and no extraperitoneal disease or Peritoneal Cancer Index >9 and extraperitoneal disease).

LIMITATIONS: The main study limitation is its observational nature.

CONCLUSIONS: A history of extraperitoneal disease is associated with poorer prognosis. However, survival benefit may be obtained in selected patients with limited peritoneal involvement. See Video Abstract at http://links.lww.com/DCR/A655.

Original languageEnglish
Pages (from-to)1026-1034
Number of pages9
JournalDiseases of the Colon and Rectum
Volume61
Issue number9
DOIs
Publication statusPublished - Sep 2018

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Colorectal Neoplasms
Neoplasm Metastasis
Drug Therapy
Peritoneal Diseases
Survival
Neoplasms
Lung
Groin
Liver
Mitomycin
Cisplatin
Liver Diseases
Multivariate Analysis
Lymph Nodes
Outcome Assessment (Health Care)
Databases

Keywords

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols/adverse effects
  • Colorectal Neoplasms/mortality
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures/adverse effects
  • Female
  • Humans
  • Hyperthermia, Induced/adverse effects
  • Male
  • Middle Aged
  • Peritoneal Neoplasms/mortality
  • Peritoneum/pathology
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome

Cite this

@article{02e401e5d62f468285dcc12af3f7070d,
title = "Should a History of Extraperitoneal Disease Be a Contraindication to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Metastases?",
abstract = "BACKGROUND: Survival improvements have been reported in selected patients affected by colorectal peritoneal metastases who were undergoing cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. Treatment of peritoneal metastases associated with extraperitoneal disease is still controversial.OBJECTIVE: We assessed the prognostic impact of a history of extraperitoneal disease that was curatively treated either at the same time as or before the onset of peritoneal metastases.DESIGN: We reviewed 2 prospective databases. Peritoneal involvement was scored by Peritoneal Cancer Index.SETTINGS: Our study was conducted in 2 high-volume peritoneal malignancy management institutions.PATIENTS: A total of 148 patients with peritoneal metastases were included. In 27 patients, extraperitoneal disease involving the liver (n = 23), lung (n = 1), both lung and liver (n = 2), or inguinal lymph nodes and liver (n = 1) was curatively treated either simultaneously with peritoneal metastases (n = 22) or before their onset (n = 5).INTERVENTIONS: All of the macroscopic tumors were removed by means of peritonectomy procedures and visceral resections. Microscopic residual disease was treated by mitomycin C/cisplatin-based hyperthermic intraperitoneal chemotherapy.MAIN OUTCOME MEASURES: Overall survival was the primary outcome measure.RESULTS: After a median follow-up of 34.6 months (95{\%} CI, 22.6-65.7 mo), 5-year survival of patients treated for both peritoneal and extraperitoneal disease versus peritoneal metastases alone was 16.5{\%} versus 52.0{\%} (p = 0.019). After multivariate analysis, reduced survival correlated with extraperitoneal disease (p = 0.001), Peritoneal Cancer Index >19 (p = 0.004), and peritoneal residual disease >2.5 mm (p = 0.018). Three prognostic groups were defined, and median survival was not reached for group 1 (Peritoneal Cancer Index ≤19 and no extraperitoneal disease), reached in 27.0 months for group 2 (Peritoneal Cancer Index ≤9 and extraperitoneal disease), and reached in 11.6 months for group 3 (Peritoneal Cancer Index >19 and no extraperitoneal disease or Peritoneal Cancer Index >9 and extraperitoneal disease).LIMITATIONS: The main study limitation is its observational nature.CONCLUSIONS: A history of extraperitoneal disease is associated with poorer prognosis. However, survival benefit may be obtained in selected patients with limited peritoneal involvement. See Video Abstract at http://links.lww.com/DCR/A655.",
keywords = "Aged, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Colorectal Neoplasms/mortality, Combined Modality Therapy, Cytoreduction Surgical Procedures/adverse effects, Female, Humans, Hyperthermia, Induced/adverse effects, Male, Middle Aged, Peritoneal Neoplasms/mortality, Peritoneum/pathology, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome",
author = "Dario Baratti and Shigeki Kusamura and Domenico Iusco and Christian Cotsoglou and Marcello Guaglio and Luigi Battaglia and Salvatore Virz{\`i} and Vincenzo Mazzaferro and Marcello Deraco",
year = "2018",
month = "9",
doi = "10.1097/DCR.0000000000001156",
language = "English",
volume = "61",
pages = "1026--1034",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Should a History of Extraperitoneal Disease Be a Contraindication to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Metastases?

AU - Baratti, Dario

AU - Kusamura, Shigeki

AU - Iusco, Domenico

AU - Cotsoglou, Christian

AU - Guaglio, Marcello

AU - Battaglia, Luigi

AU - Virzì, Salvatore

AU - Mazzaferro, Vincenzo

AU - Deraco, Marcello

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: Survival improvements have been reported in selected patients affected by colorectal peritoneal metastases who were undergoing cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. Treatment of peritoneal metastases associated with extraperitoneal disease is still controversial.OBJECTIVE: We assessed the prognostic impact of a history of extraperitoneal disease that was curatively treated either at the same time as or before the onset of peritoneal metastases.DESIGN: We reviewed 2 prospective databases. Peritoneal involvement was scored by Peritoneal Cancer Index.SETTINGS: Our study was conducted in 2 high-volume peritoneal malignancy management institutions.PATIENTS: A total of 148 patients with peritoneal metastases were included. In 27 patients, extraperitoneal disease involving the liver (n = 23), lung (n = 1), both lung and liver (n = 2), or inguinal lymph nodes and liver (n = 1) was curatively treated either simultaneously with peritoneal metastases (n = 22) or before their onset (n = 5).INTERVENTIONS: All of the macroscopic tumors were removed by means of peritonectomy procedures and visceral resections. Microscopic residual disease was treated by mitomycin C/cisplatin-based hyperthermic intraperitoneal chemotherapy.MAIN OUTCOME MEASURES: Overall survival was the primary outcome measure.RESULTS: After a median follow-up of 34.6 months (95% CI, 22.6-65.7 mo), 5-year survival of patients treated for both peritoneal and extraperitoneal disease versus peritoneal metastases alone was 16.5% versus 52.0% (p = 0.019). After multivariate analysis, reduced survival correlated with extraperitoneal disease (p = 0.001), Peritoneal Cancer Index >19 (p = 0.004), and peritoneal residual disease >2.5 mm (p = 0.018). Three prognostic groups were defined, and median survival was not reached for group 1 (Peritoneal Cancer Index ≤19 and no extraperitoneal disease), reached in 27.0 months for group 2 (Peritoneal Cancer Index ≤9 and extraperitoneal disease), and reached in 11.6 months for group 3 (Peritoneal Cancer Index >19 and no extraperitoneal disease or Peritoneal Cancer Index >9 and extraperitoneal disease).LIMITATIONS: The main study limitation is its observational nature.CONCLUSIONS: A history of extraperitoneal disease is associated with poorer prognosis. However, survival benefit may be obtained in selected patients with limited peritoneal involvement. See Video Abstract at http://links.lww.com/DCR/A655.

AB - BACKGROUND: Survival improvements have been reported in selected patients affected by colorectal peritoneal metastases who were undergoing cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. Treatment of peritoneal metastases associated with extraperitoneal disease is still controversial.OBJECTIVE: We assessed the prognostic impact of a history of extraperitoneal disease that was curatively treated either at the same time as or before the onset of peritoneal metastases.DESIGN: We reviewed 2 prospective databases. Peritoneal involvement was scored by Peritoneal Cancer Index.SETTINGS: Our study was conducted in 2 high-volume peritoneal malignancy management institutions.PATIENTS: A total of 148 patients with peritoneal metastases were included. In 27 patients, extraperitoneal disease involving the liver (n = 23), lung (n = 1), both lung and liver (n = 2), or inguinal lymph nodes and liver (n = 1) was curatively treated either simultaneously with peritoneal metastases (n = 22) or before their onset (n = 5).INTERVENTIONS: All of the macroscopic tumors were removed by means of peritonectomy procedures and visceral resections. Microscopic residual disease was treated by mitomycin C/cisplatin-based hyperthermic intraperitoneal chemotherapy.MAIN OUTCOME MEASURES: Overall survival was the primary outcome measure.RESULTS: After a median follow-up of 34.6 months (95% CI, 22.6-65.7 mo), 5-year survival of patients treated for both peritoneal and extraperitoneal disease versus peritoneal metastases alone was 16.5% versus 52.0% (p = 0.019). After multivariate analysis, reduced survival correlated with extraperitoneal disease (p = 0.001), Peritoneal Cancer Index >19 (p = 0.004), and peritoneal residual disease >2.5 mm (p = 0.018). Three prognostic groups were defined, and median survival was not reached for group 1 (Peritoneal Cancer Index ≤19 and no extraperitoneal disease), reached in 27.0 months for group 2 (Peritoneal Cancer Index ≤9 and extraperitoneal disease), and reached in 11.6 months for group 3 (Peritoneal Cancer Index >19 and no extraperitoneal disease or Peritoneal Cancer Index >9 and extraperitoneal disease).LIMITATIONS: The main study limitation is its observational nature.CONCLUSIONS: A history of extraperitoneal disease is associated with poorer prognosis. However, survival benefit may be obtained in selected patients with limited peritoneal involvement. See Video Abstract at http://links.lww.com/DCR/A655.

KW - Aged

KW - Antineoplastic Combined Chemotherapy Protocols/adverse effects

KW - Colorectal Neoplasms/mortality

KW - Combined Modality Therapy

KW - Cytoreduction Surgical Procedures/adverse effects

KW - Female

KW - Humans

KW - Hyperthermia, Induced/adverse effects

KW - Male

KW - Middle Aged

KW - Peritoneal Neoplasms/mortality

KW - Peritoneum/pathology

KW - Prognosis

KW - Retrospective Studies

KW - Survival Rate

KW - Treatment Outcome

U2 - 10.1097/DCR.0000000000001156

DO - 10.1097/DCR.0000000000001156

M3 - Article

C2 - 30086051

VL - 61

SP - 1026

EP - 1034

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 9

ER -