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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2023

01-09-2023 | Metastasis | Colorectal Cancer

Clinical Impact of Radical Resection of Synchronous and Metachronous Peritoneal Metastases from Colorectal Cancer

Authors: Aina Kunitomo, MD, Akira Ouchi, MD, PhD, Koji Komori, MD, PhD, Takashi Kinoshita, MD, PhD, Yusuke Sato, MD, PhD, Tetsuya Abe, MD, PhD, Seiji Ito, MD, PhD, Tsuyoshi Sano, MD, PhD, Yasuhiro Shimizu, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2023

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Abstract

Background

According to some case series, patients with colorectal cancer (CRC) who underwent radical resection of synchronous peritoneal metastases (PM) with the primary tumor had better survival than patients who underwent non-surgical treatment. However, little evidence exists regarding the significance of radical resection for metachronous PM.

Objective

This study aimed to evaluate the clinical significance of surgical intervention for isolated PM from CRC, with a particular focus on time to PM.

Methods

A total of 74 consecutive patients with isolated PM from CRC, including 40 and 34 patients with synchronous and metachronous PM, respectively, treated between 2007 and 2018 were retrospectively analyzed. The primary outcome measure was overall survival (OS) from diagnosis, and the OS was compared between radical resection and palliative chemotherapy.

Results

Five-year OS was 39.7% for all patients. Patients with radical resection had significantly better 5-year OS compared with those with palliative chemotherapy (62.8% vs. 11.0%; p < 0.0001). According to time to PM, patients with radical resection had significantly better 5-year OS compared with those with palliative chemotherapy for both synchronous PM (47.6% vs. 0%; p = 0.019) and metachronous PM (77.2% vs. 15.2%; p < 0.0001). Multivariable analysis stratified by time to PM revealed that surgical intervention is a significant favorable prognostic factor only in patients with metachronous PM (hazard ratio 0.117, 95% confidence interval 0.020–0.678; p = 0.017).

Conclusions

Patients with radical resection of PM had good survival compared with those with chemotherapy alone, especially for metachronous PM. Surgical intervention should be considered for isolated metachronous PM when radical resection is feasible.
Appendix
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Literature
1.
Wild CP, Weiderpass E, Stewart BW. World Cancer Report: Reseach for Cancer Prevention. Lyon: International Agency for Research on Cancer, World Health Organization; 2020. pp. 344-54.
2.
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 randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17:1709–19.CrossRefPubMed
3.
UICC TNM classification of malignant tumors, 8th edition. New York: Wiley; 2017.
4.
Sugarbaker PH, Ryan DP. Cytoreductive surgery plus hyperthermic perioperative chemotherapy to treat peritoneal metastases from colorectal cancer: standard of care or an experimental approach? Lancet Oncol. 2012;13:e362–9.CrossRefPubMed
5.
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
6.
Quénet F, Elias D, Roca L, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22:256–66.CrossRefPubMed
7.
Mulsow J, Merkel S, Agaimy A, Hohenberger W. Outcomes following surgery for colorectal cancer with synchronous peritoneal metastases. Br J Surg. 2011;98:1785–91.CrossRefPubMed
8.
Kobayashi H, Kotake K, Funahashi K, et al. Clinical benefit of surgery for stage IV colorectal cancer with synchronous peritoneal metastasis. J Gastroenterol. 2014;49:646–54.CrossRefPubMed
9.
Shida D, Tsukamoto S, Ochiai H, Kanemitsu Y. Long-Term Outcomes After R0 Resection of Synchronous Peritoneal Metastasis from Colorectal Cancer Without Cytoreductive Surgery or Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol. 2018;25:173–8.CrossRefPubMed
10.
Kobayashi H, Kotake K, Sugihara K. Impact of R0 resection for synchronous peritoneal metastasis from colorectal cancer: A propensity score-matched analysis of a multi-institutional database. Annals of Gastroenterological Surgery. 2021;5:221–7.CrossRefPubMed
11.
Nagata H, Ishihara S, Hata K, et al. Survival and Prognostic Factors for Metachronous Peritoneal Metastasis in Patients with Colon Cancer. Ann Surg Oncol. 2017;24:1269–80.CrossRefPubMed
12.
Japanese Society for Cancer of the Colon and Rectum, Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition [secondary publication]. J Anus Rectum Colon 2019; 3: 175-195
13.
Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42.CrossRefPubMed
14.
Benson AB, Venook AP, Al-Hawary MM, et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19:329–59.CrossRefPubMed
15.
Väyrynen V, Wirta EV, Seppälä T, et al. Incidence and management of patients with colorectal cancer and synchronous and metachronous colorectal metastases: a population-based study. BJS Open. 2020;4:685–92.CrossRefPubMedPubMedCentral
16.
Tsilimigras DI, Ntanasis-Stathopoulos I, Bagante F, et al. Clinical significance and prognostic relevance of KRAS, BRAF, PI3K and TP53 genetic mutation analysis for resectable and unresectable colorectal liver metastases: a systematic review of the current evidence. Surg Oncol. 2018;27:280–8.CrossRefPubMed
17.
Johnson B, Jin Z, Truty MJ, et al. Impact of Metastasectomy in the Multimodality Approach for BRAF V600E Metastatic Colorectal Cancer: The Mayo Clinic Experience. Oncologist. 2018;23:128–34.CrossRefPubMed
18.
Yaeger R, Cercek A, Chou JF, et al. BRAF mutation predicts for poor outcomes after metastasectomy in patients with metastatic colorectal cancer. Cancer. 2014;120:2316–24.CrossRefPubMed
19.
Prasanna T, Wong R, Price T, et al. Metastasectomy and BRAF mutation; an analysis of survival outcome in metastatic colorectal cancer. Curr Probl Cancer. 2021;45:100637.CrossRefPubMed
Metadata
Title
Clinical Impact of Radical Resection of Synchronous and Metachronous Peritoneal Metastases from Colorectal Cancer
Authors
Aina Kunitomo, MD
Akira Ouchi, MD, PhD
Koji Komori, MD, PhD
Takashi Kinoshita, MD, PhD
Yusuke Sato, MD, PhD
Tetsuya Abe, MD, PhD
Seiji Ito, MD, PhD
Tsuyoshi Sano, MD, PhD
Yasuhiro Shimizu, MD, PhD
Publication date
01-09-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14191-y

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