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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2015

01-04-2015 | Colorectal Cancer

Peritoneal Cancer Patients Not Suitable for Cytoreductive Surgery and HIPEC During Explorative Surgery: Risk Factors, Treatment Options, and Prognosis

Authors: T. R. van Oudheusden, MD, H. J. Braam, M. D. P. Luyer, M. J. Wiezer, B. van Ramshorst, S. W. Nienhuijs, I. H. J. T. de Hingh

Published in: Annals of Surgical Oncology | Issue 4/2015

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Abstract

Background

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is currently the only curative option for patients with peritoneal carcinomatosis of colorectal origin. Despite meticulous preoperative assessment, CRS and HIPEC appear to be impossible in a subset of patients at the time of surgery. This study investigated which clinical factors may identify these patients before surgery and reported on factors influencing survival.

Methods

All patients with PC of colorectal origin between April 2005 and November 2013 who underwent exploratory surgery to determine whether cytoreduction and HIPEC was feasible were included in this study. Details concerning preoperative patient characteristics, perioperative outcomes, treatment and survival were compared.

Results

In total, 350 patients with PC were referred to evaluate the possibility of CRS + HIPEC of which 268 (76.6 %) underwent CRS and HIPEC and 82 (23.4 %) had an open-close procedure. The main reason for discontinuing surgery was widespread peritoneal disease (50 %). A preoperative ostomy and an ASA score of 3 were associated with an increased risk for “open and close” (O&C). Median survival was 11.2 months in patients treated with palliative chemotherapy (75 %) compared with 2.7 months with palliative care only.

Conclusions

CRS and HIPEC were deemed unsuitable in almost a quarter of all patients undergoing surgery. No strong clinical predictors for O&C were found, stressing the need for better preoperative imaging modalities. Survival in these patients is limited, but the majority could be treated with palliative chemotherapy resulting in survival of almost 1 year.
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Metadata
Title
Peritoneal Cancer Patients Not Suitable for Cytoreductive Surgery and HIPEC During Explorative Surgery: Risk Factors, Treatment Options, and Prognosis
Authors
T. R. van Oudheusden, MD
H. J. Braam
M. D. P. Luyer
M. J. Wiezer
B. van Ramshorst
S. W. Nienhuijs
I. H. J. T. de Hingh
Publication date
01-04-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 4/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4148-x

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