Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery
Abstract Background Colorectal peritoneal metastases (CRPM) affects 15% of patients at initial colorectal cancer diagnosis. Neoadjuvant chemotherapy (NAC) prior to cytoreductive surgery (CRS) has been demonstrated to be a safe and feasible option, however there is limited data describing its efficac...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12957-024-03392-8 |
| _version_ | 1827277081925386240 |
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| author | Mina Sarofim Ruwanthi Wijayawardana Nima Ahmadi Shoma Barat Winston Liauw David L Morris |
| author_facet | Mina Sarofim Ruwanthi Wijayawardana Nima Ahmadi Shoma Barat Winston Liauw David L Morris |
| author_sort | Mina Sarofim |
| collection | DOAJ |
| description | Abstract Background Colorectal peritoneal metastases (CRPM) affects 15% of patients at initial colorectal cancer diagnosis. Neoadjuvant chemotherapy (NAC) prior to cytoreductive surgery (CRS) has been demonstrated to be a safe and feasible option, however there is limited data describing its efficacy in advanced peritoneal disease. This study evaluated the effect of NAC on survival in patients with high volume CRPM undergoing CRS with or without HIPEC. Methods A retrospective review of all patients who underwent CRS with or without HIPEC for CRPM from 2004 to 2019 at our institution was performed. The cohort was divided based on peritoneal carcinomatosis index (PCI) at surgery: Low Volume (PCI ≤ 16) and High Volume (PCI > 16). Results A total of 326 patients underwent CRS with HIPEC for CRPM. There were 39 patients (12%) with High Volume disease, and 15 of these (38%) received NAC. Patients with High Volume disease had significantly longer operating time, lower likelihood of complete macroscopic cytoreduction (CC-0 score), longer intensive care unit length of stay and longer hospital stay compared to Low Volume disease. In High Volume disease, the NAC group had a significantly shorter median survival of 14.4 months compared to 23.8 months in the non-NAC group (p = 0.046). Conclusion Patients with High Volume CRPM achieved good median survival following CRS with HIPEC, which challenges the current PCI threshold for offering CRS. The use of NAC in this cohort did not increase perioperative morbidity but was associated with significantly shorter median survival compared to upfront surgery. |
| first_indexed | 2024-04-24T07:14:55Z |
| format | Article |
| id | doaj.art-337d8129953946d6b9400432b954cf21 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-04-24T07:14:55Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-337d8129953946d6b9400432b954cf212024-04-21T11:20:53ZengBMCWorld Journal of Surgical Oncology1477-78192024-04-012211710.1186/s12957-024-03392-8Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgeryMina Sarofim0Ruwanthi Wijayawardana1Nima Ahmadi2Shoma Barat3Winston Liauw4David L Morris5Liver and Peritonectomy Unit, St George HospitalLiver and Peritonectomy Unit, St George HospitalLiver and Peritonectomy Unit, St George HospitalLiver and Peritonectomy Unit, St George HospitalSchool of Medicine, University of New South WalesLiver and Peritonectomy Unit, St George HospitalAbstract Background Colorectal peritoneal metastases (CRPM) affects 15% of patients at initial colorectal cancer diagnosis. Neoadjuvant chemotherapy (NAC) prior to cytoreductive surgery (CRS) has been demonstrated to be a safe and feasible option, however there is limited data describing its efficacy in advanced peritoneal disease. This study evaluated the effect of NAC on survival in patients with high volume CRPM undergoing CRS with or without HIPEC. Methods A retrospective review of all patients who underwent CRS with or without HIPEC for CRPM from 2004 to 2019 at our institution was performed. The cohort was divided based on peritoneal carcinomatosis index (PCI) at surgery: Low Volume (PCI ≤ 16) and High Volume (PCI > 16). Results A total of 326 patients underwent CRS with HIPEC for CRPM. There were 39 patients (12%) with High Volume disease, and 15 of these (38%) received NAC. Patients with High Volume disease had significantly longer operating time, lower likelihood of complete macroscopic cytoreduction (CC-0 score), longer intensive care unit length of stay and longer hospital stay compared to Low Volume disease. In High Volume disease, the NAC group had a significantly shorter median survival of 14.4 months compared to 23.8 months in the non-NAC group (p = 0.046). Conclusion Patients with High Volume CRPM achieved good median survival following CRS with HIPEC, which challenges the current PCI threshold for offering CRS. The use of NAC in this cohort did not increase perioperative morbidity but was associated with significantly shorter median survival compared to upfront surgery.https://doi.org/10.1186/s12957-024-03392-8Colorectal cancerPeritoneal metastasesCytoreductive surgeryNeoadjuvant chemotherapyHIPEC |
| spellingShingle | Mina Sarofim Ruwanthi Wijayawardana Nima Ahmadi Shoma Barat Winston Liauw David L Morris Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery World Journal of Surgical Oncology Colorectal cancer Peritoneal metastases Cytoreductive surgery Neoadjuvant chemotherapy HIPEC |
| title | Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery |
| title_full | Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery |
| title_fullStr | Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery |
| title_full_unstemmed | Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery |
| title_short | Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery |
| title_sort | neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery |
| topic | Colorectal cancer Peritoneal metastases Cytoreductive surgery Neoadjuvant chemotherapy HIPEC |
| url | https://doi.org/10.1186/s12957-024-03392-8 |
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