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Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy for the Management of Peritoneal Carcinomatosis From Colorectal Cancer: A Multi-Institutional Study

From the Centre Hospitalo-Universitaire Lyon Sud, Pierre Bénite; Equipe Accueil 3738, Université Claude Bernard Lyon 1, Oullins; Centre Jean Perrin, Clermont-Ferrand; Institut Gustave Roussy, Villejuif; Centre Val d’Aurelle, Montpellier; Centre Paul Papin, Angers; Centre Hospitalo-Universitaire l’Archet 2, Nice; Centre Hospitalier de Bellevue, Saint-Etienne; Centre Hospitalo-Universitaire, Dijon, France; Shizuoka Cancer Centre, Shizuoka, Japan; Tel Aviv Medical Center, Tel Aviv, Israel; Didimotichon General Hospital, Didimotichon, Greece; San Giuseppe Hospital, Empoli, Florence; Regina Elena National Cancer Institute, Roma; Istituto Nazional Tumori, Milano; Hospital Santiago Apostol, Vitoria, Spain; Washington Hospital Center, Washington, DC; Wake Forest University, Baptist Medical Center, Department of General Surgery, Winston-Salem, NC; and SharpHealthCare, San Diego, CA

Address reprint requests to Francois N. Gilly, MD, PhD, Surgical Department, Centre Hospitalo Universitaire Lyon Sud, 69495 Pierre Bénite cedex, France; e-mail: francogi{at}lyon-sud.univ-lyon1.fr

PURPOSE: The three principal studies dedicated to the natural history of peritoneal carcinomatosis (PC) from colorectal cancer consistently showed median survival ranging between 6 and 8 months. New approaches combining cytoreductive surgery and perioperative intraperitoneal chemotherapy suggest improved survival.

PATIENTS AND METHODS: A retrospective multicenter study was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy). PC from appendiceal origin was excluded.

RESULTS: The study included 506 patients from 28 institutions operated between May 1987 and December 2002. Their median age was 51 years. The median follow-up was 53 months. The morbidity and mortality rates were 22.9% and 4%, respectively. The overall median survival was 19.2 months. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months, compared with 8.4 months for patients in whom complete cytoreductive surgery was not possible (P < .001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis, and poor histologic differentiation were negative independent prognostic indicators.

CONCLUSION: The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.

Presented in part at the American Society of Clinical Oncology Symposium (Merit Award), San Francisco, CA, January 2004.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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