The treatment of peritoneal carcinomatosis of colorectal cancer with complete cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) with oxaliplatin : a Belgian multicentre prospective phase II clinical study
Faculty of Medicine and Health Sciences
Annals of surgical oncology. - Philadelphia, Pa
, p. 2186-2194
Background Up to 25% of patients with metastatic colorectal cancer (CRC) present with peritoneal carcinomatosis (PC) as the only site of metastases. Complete cytoreductive surgery (CCRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) aims for locoregional disease control and long-term survival. Oxaliplatin is effective for treating advanced CRC. This study assesses the safety and efficacy of CCRS with HIPEC with oxaliplatin for patients with PC of CRC. Methods A Belgian prospective multicenter registry was performed to monitor perioperative morbidity and assess mortality, disease-free survival (DFS), and overall survival (OS). Results Forty-eight consecutive patients underwent CCRS (R0/1) with HIPEC (male/female ratio 17/31, median age 60 years, range 2476 years). Median PC index was 11 (range 122). Median operation time was 460 (range 125840) min, with a median blood loss of 475 (range 26,000) ml. Thirty-day mortality was 0%. Complication rate (any grade) was 52.1%. Anastomotic leakage occurred in 10.4% of patients, bleeding in 6.3%, and bowel perforation in 2.1%. Median hospital stay was 20 (range 565) days. At median follow-up of 22.7 (range 3.255.7) months, OS was 97.9% [95% confidence interval (CI) 86.199.7] at 1 year and 88.7% (95% CI 73.695.4) at 2 years. DFS at 1 year was 65.8% (95% CI 52.376.2) and 45.5% (95% CI 34.355.9) at 2 years. Median time until recurrence was 19.8 months (95% CI 12upper limit not defined). Only after dichotomizing PC index was a significant difference in OS found between low and high PC index. Conclusions CCRS followed by HIPEC with oxaliplatin for PC from CRC can be implemented with acceptable morbidity. Long-term DFS and OS can be achieved in selected patients.