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Annals of Surgical Oncology
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03-01-2024 | Cytostatic Therapy | Peritoneal Surface Malignancy

Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence

Authors: Rémi Grange, MD, Pascal Rousset, MD, PhD, Nicolas Williet, MD, PhD, Mathias Guesnon, MD, Laurent Milot, MD, PhD, Guillaume Passot, MD, PhD, Jean-Marc Phelip, MD, PhD, Bertrand Le Roy, MD, PhD, Olivier Glehen, MD, PhD, Vahan Kepenekian, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2024

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Abstract

Background

Selection of colorectal cancer patients with concomitant peritoneal (PM) and liver metastases (LM) for radical treatment with cytoreductive surgery (CRS), including liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), needs improvement. This retrospective, monocentric study was designed to evaluate the predictive factors for early recurrence, disease-free survival (DFS), and overall survival (OS) in such patients treated in a referral center.

Methods

Consecutive colorectal cancer patients with concomitant LM and PM treated with curative intent with perioperative systemic chemotherapy, simultaneous complete CRS, liver resection, and HIPEC in 2011–2022 were included. Clinical, radiological (before and after preoperative chemotherapy), surgical, and pathological data were investigated, along with long-term oncologic outcomes. A multivariate analysis was performed to identify predictive factors associated with early recurrence (diagnosed <6 months after surgery), DFS, and OS.

Results

Of more than 61 patients included, 31 (47.1%) had pT4 and 27 (40.9%) had pN2 primary tumors. Before preoperative chemotherapy, the median number of LM was 2 (1–4). The median surgical PCI (peritoneal carcinomatosis index) was 3 (5–8.5). The median DFS and OS were 8.15 (95% confidence interval [CI] 5.5–10.1) and 34.1 months (95% CI 28.1–53.5), respectively. In multivariate analysis, pT4 (odds ratio [OR] = 4.14 [1.2–16.78], p = 0.032]) and pN2 (OR = 3.7 [1.08–13.86], p = 0.042) status were independently associated with an early recurrence, whereas retroperitoneal lymph node metastasis (hazard ratio [HR] = 39 [8.67–175.44], p < 0.001) was independently associated with poor OS.

Conclusions

In colorectal cancer patients with concomitant PM and LM, an advanced primary tumor (pT4 and/or pN2) was associated with a higher risk of early recurrence following a radical multimodal treatment, whereas RLN metastases was strongly detrimental for OS.
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Metadata
Title
Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence
Authors
Rémi Grange, MD
Pascal Rousset, MD, PhD
Nicolas Williet, MD, PhD
Mathias Guesnon, MD
Laurent Milot, MD, PhD
Guillaume Passot, MD, PhD
Jean-Marc Phelip, MD, PhD
Bertrand Le Roy, MD, PhD
Olivier Glehen, MD, PhD
Vahan Kepenekian, MD, PhD
Publication date
03-01-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14840-2

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