Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2019

01-02-2019 | Gastrointestinal Oncology

Sites of Recurrence After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Carcinomatosis from Colorectal and Appendiceal Adenocarcinoma: A Tertiary Center Experience

Authors: Yael Feferman, MD, Daniel Solomon, MD, Shanel Bhagwandin, DO, MPH, Joseph Kim, MD, Samantha N. Aycart, BS, Daniela Feingold, BA, Umut Sarpel, MD, Daniel M. Labow, MD

Published in: Annals of Surgical Oncology | Issue 2/2019

Login to get access

Abstract

Background

This report describes patterns of disease recurrence after optimal cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) of colorectal (CRC) and appendiceal adenocarcinoma (AC) origin.

Methods

Patients undergoing optimal CRS/HIPEC (2007–2016) at the authors’ institution were retrospectively reviewed from a prospectively maintained database. Data regarding disease recurrence were analyzed.

Results

Of 74 patients who underwent CRS/HIPEC for PC from CRC (n = 46) or AC (n = 28), 49 (66%) had recurrence during a median follow-up period of 39.5 months. The sites of recurrence were peritoneal-only (n = 34, 69%), hematogenous-only (n = 6, 12%), and combined peritoneal and hematogenous (n = 9, 19%) sites. No patients with AC had hematogenous-only recurrence. The median disease-free survival (DFS) time for all the patients was 15 months (95% confidence interval [CI] 12.5–17.5 months). The recurrence rate after CRS/HIPEC was 41% at 1 year, 73% at 3 years, and 76% at 5 years. All the patients with hematogenous-only metastases experienced recurrence within 12 months after CRS/HIPEC. Mucinous or signet ring features predicted peritoneal recurrence (p = 0.041), whereas a complete cytoreduction of 1 was a predictor of early recurrence (p = 0.040). Patients who underwent repeat cytoreduction survived longer than those who received systemic chemotherapy alone. The median survival time after peritoneal-only recurrence was 33 months (95% CI 27.8–38.9 months).

Conclusion

Recurrence for patients with PC is common, even after optimal CRS/HIPEC. Hematogenous-only recurrence occurs early after CRS/HIPEC, suggesting occult disease at the time of treatment and highlighting the need for methods to identify micro-metastases and improve patient selection. Patients experiencing peritoneal-only recurrence had long survival period after CRS/HIPEC, suggesting its effectiveness at controlling peritoneal disease for a time.
Literature
1.
2.
Benedix F, Reimer A, Gastinger I, Mroczkowski P, Lippert H, Kube R. Primary appendiceal carcinoma: epidemiology, surgery, and survival: results of a German multi-center study. Eur J Surg Oncol. 2010;36:763–71.CrossRefPubMed
3.
Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003; 21:3737–43.CrossRefPubMed
4.
Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomized trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17:1709–19.CrossRefPubMed
5.
Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2009;28:63–8.CrossRefPubMed
6.
Levine EA, Stewart JH, Russell GB, Geisinger KR, Loggie BL, Shen P. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg. 2007;204:943–53.CrossRefPubMed
7.
Riss S, Mohamed F, Dayal S, et al. Peritoneal metastases from colorectal cancer: patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2013;39:931–7.CrossRefPubMed
8.
Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.CrossRefPubMed
9.
Tabrizian P, Shrager B, Jibara G, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: outcomes from a single tertiary institution. J Gastrointest Surg. 2014;18:1024–31.CrossRefPubMed
10.
Verwaal VJ, Boot H, Aleman BMP, van Tinteren H, Zoetmulder FAN. Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome. Ann Surg Oncol. 2004;11:375–9.CrossRefPubMed
11.
Navez J, Remue C, Leonard D, et al. Surgical treatment of colorectal cancer with peritoneal and liver metastases using combined liver and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: report from a single-centre experience. Ann Surg Oncol. 2016;23:666–73.CrossRefPubMed
12.
Königsrainer I, Horvath P, Struller F, Forkl V, Königsrainer A, Beckert S. Risk factors for recurrence following complete cytoreductive surgery and HIPEC in colorectal cancer-derived peritoneal surface malignancies. Langenbecks Arch Surg. 2013;398:745–9.CrossRefPubMed
13.
Cashin PH, Graf W, Nygren P, Mahteme H. Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: prognosis and treatment of recurrences in a cohort study. Eur J Surg Oncol. 2012;38:509–15.CrossRefPubMed
14.
Bijelic L, Yan TD, Sugarbaker PH. Failure analysis of recurrent disease following complete cytoreduction and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Ann Surg Oncol. 2007;14:2281–8.CrossRefPubMed
15.
Braam HJ, van Oudheusden TR, de Hingh IHJT, et al. Patterns of recurrence following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. J Surg Oncol. 2014;109:841–7.CrossRefPubMed
16.
Franssen B, Tabrizian P, Weinberg A, et al. Outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on patients with diaphragmatic involvement. Ann Surg Oncol. 2015;22:1639–44.CrossRefPubMed
17.
Berger Y, Aycart S, Tabrizian P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with liver involvement. J Surg Oncol. 2016;113:432–7.CrossRefPubMed
18.
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMed
19.
Turaga K, Levine E, Barone R, et al. Consensus guidelines from the American Society of Peritoneal Surface Malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States. Ann Surg Oncol. 2014;21:1501–5.CrossRefPubMed
20.
Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well-defined population. Br J Surg. 2006;93:1115–22.CrossRefPubMed
21.
Platell CF. Changing patterns of recurrence after treatment for colorectal cancer. Int J Colorectal Dis. 2007;22:1223–31.CrossRefPubMed
22.
Gilbert JM, Jeffrey I, Evans M, Kark AE. Sites of recurrent tumour after “curative” colorectal surgery: implications for adjuvant therapy. Br J Surg. 1984;71:203–5.CrossRefPubMed
23.
Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. The pattern of recurrent colorectal cancer in a prospective randomised study and the characteristics of diagnostic tests. Int J Colorectal Dis. 1997;12:329–34.CrossRefPubMed
24.
Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg. 1997;84:666–9.CrossRefPubMed
25.
26.
Grotz TE, Overman MJ, Eng C, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for moderately and poorly differentiated appendiceal adenocarcinoma: survival outcomes and patient selection. Ann Surg Oncol. 2017;24:2646–54.CrossRefPubMed
27.
Lieu CH, Lambert LA, Wolff RA, et al. Systemic chemotherapy and surgical cytoreduction for poorly differentiated and signet ring cell adenocarcinomas of the appendix. Ann Oncol. 2012;23:652–8.CrossRefPubMed
Metadata
Title
Sites of Recurrence After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Carcinomatosis from Colorectal and Appendiceal Adenocarcinoma: A Tertiary Center Experience
Authors
Yael Feferman, MD
Daniel Solomon, MD
Shanel Bhagwandin, DO, MPH
Joseph Kim, MD
Samantha N. Aycart, BS
Daniela Feingold, BA
Umut Sarpel, MD
Daniel M. Labow, MD
Publication date
01-02-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6860-4

Other articles of this Issue 2/2019

Annals of Surgical Oncology 2/2019 Go to the issue

Translational Research and Biomarkers

Epigenetic Status of CDO1 Gene May Reflect Chemosensitivity in Colon Cancer with Postoperative Adjuvant Chemotherapy

Urologic Oncology

Important Therapeutic Considerations in T1b Penile Cancer: Prognostic Significance and Adherence to Treatment Guidelines

Endocrine Tumors

Patterns of Lymph Node Recurrence in Adrenocortical Carcinoma: Possible Implications for Primary Surgical Treatment

Head and Neck Oncology

Does p16+ Predict a Favorable Prognosis for Oropharyngeal Cancer? Risk Factors for Treatment Failure for Patients Who Underwent Surgery-Based Therapy

Breast Oncology

Multifocal/Multicentric Ipsilateral Invasive Breast Carcinomas with Similar Histology: Is Multigene Testing of All Individual Foci Necessary?

Peritoneal Surface Malignancy

Restrictive Intraoperative Fluid Therapy is Associated with Decreased Morbidity and Length of Stay Following Hyperthermic Intraperitoneal Chemoperfusion