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Article Dans Une Revue Journal of Surgical Oncology Année : 2019

Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience

Nayef Alzahrani
  • Fonction : Auteur
Sarah Valle
  • Fonction : Auteur
Oliver Fisher
  • Fonction : Auteur
Yutaka Yonemura
  • Fonction : Auteur
Cécile Brigand
  • Fonction : Auteur
  • PersonId : 907735
Ignace Hingh
  • Fonction : Auteur
Vic Verwaal
  • Fonction : Auteur
Dario Baratti
  • Fonction : Auteur
  • PersonId : 901501
Mark Pocard
Loreen Maerz
  • Fonction : Auteur
Edward Levine
  • Fonction : Auteur
Frederic Dumont
  • Fonction : Auteur
Mathew Kozman
  • Fonction : Auteur
Winston Liauw
  • Fonction : Auteur

Résumé

Background and Objectives: The aims of this multi‐institutional study were to assess the feasibility of iterative cytoreductive surgery (iCRS)/hyperthermic intraperitoneal chemotherapy, iCRS in colorectal peritoneal carcinomatosis (CRPC), evaluate survival, recurrence, morbidity and mortality outcomes, and identify prognostic factors for overall survival. Methods: Patients with CRPC that underwent an iCRS, with or without intraperitoneal chemotherapy, from June 1993 to July 2016 at 13 institutions were retrospectively analyzed from prospectively maintained databases. Results: The study comprised of 231 patients, including 126 females (54.5%) with a mean age at iCRS of 51.3 years. The iterative high‐grade (3/4) morbidity and mortality rates were 23.4% and 1.7%, respectively. The median recurrence‐free survival was 15.0 and 10.1 months after initial and iCRS, respectively. The median and 5‐year survivals were 49.1 months and 43% and 26.4 months and 26% from the initial and iCRS, respectively. Independent negative predictors of survival from the initial CRS included peritoneal carcinomatosis index (PCI) > 20 ( P = 0.02) and lymph node positivity ( P = 0.04), and from iCRS, PCI > 10 ( P = 0.03 for PCI 11‐20; P < 0.001 for PCI > 20), high‐grade complications ( P = 0.012), and incomplete cytoreduction ( P < 0.001). Conclusion: iCRS can provide long‐term survival benefits to highly selected colorectal peritoneal carcinomatosis patients with comparable mortality and morbidity rates to the initial CRS procedure. Careful patient selection is necessary to improve overall outcomes.
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Dates et versions

hal-02060121 , version 1 (07-03-2019)

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Nayef Alzahrani, Sarah Valle, Oliver Fisher, Paul H. Sugarbaker, Yutaka Yonemura, et al.. Iterative cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi‐institutional experience. Journal of Surgical Oncology, 2019, 119 (3), pp.336-346. ⟨10.1002/jso.25277⟩. ⟨hal-02060121⟩
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