Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis
Background. For patients with colorectal cancer (CRC) peritoneal metastases (PM) who are eligible for cytoreductive surgery (CRS), the indication and timing of systemic chemotherapy (SC) are still under debate. This study aims to analyze the role of pre, post or perioperative SC on the survival and...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/6/1182 |
| _version_ | 1797241720582176768 |
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| author | Marco Tonello Carola Cenzi Elisa Pizzolato Riccardo Fiscon Paola Del Bianco Pierluigi Pilati Antonio Sommariva |
| author_facet | Marco Tonello Carola Cenzi Elisa Pizzolato Riccardo Fiscon Paola Del Bianco Pierluigi Pilati Antonio Sommariva |
| author_sort | Marco Tonello |
| collection | DOAJ |
| description | Background. For patients with colorectal cancer (CRC) peritoneal metastases (PM) who are eligible for cytoreductive surgery (CRS), the indication and timing of systemic chemotherapy (SC) are still under debate. This study aims to analyze the role of pre, post or perioperative SC on the survival and surgical complications of patients treated with CRS-HIPEC. Methods. After a systematic search in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science and Embase, a meta-analysis was performed to compare postoperative complications, disease-free survival (DFS) and overall survival (OS) according to SC administration and timing. PROSPERO: CRD42023478977. Results. Of 1203 studies screened, 15 were included in the meta-analysis (4523 patients). Post-operative SC was associated with increased overall survival (post-SC vs. no post-SC: HR 0.81, <i>p</i> = 0.00001, I<sup>2</sup> = 0%; pre-SC vs. post-SC: HR 0.65, <i>p</i> = 0.01, I<sup>2</sup> = 28%), whereas SC (pre or post) or pre-SC compared to surgery alone was not (SC vs. no SC: <i>p</i> = 0.29, I<sup>2</sup> = 80%; pre-SC vs. no pre-SC: <i>p</i> = 0.59, I<sup>2</sup> = 58%). Similar results were seen for DFS. SC was not associated with an increased complication rate (<i>p</i> = 0.47, I<sup>2</sup> = 64%). Conclusions. Systemic chemotherapy administration in patients undergoing radical surgery for colorectal peritoneal metastases is associated with increased survival only in the adjuvant/post-operative setting. Considering the limitations of the included studies, further trials are needed to answer this unresolved question. |
| first_indexed | 2024-04-24T18:27:49Z |
| format | Article |
| id | doaj.art-4ceae48096304720b0430613f2c76956 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-04-24T18:27:49Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-4ceae48096304720b0430613f2c769562024-03-27T13:30:03ZengMDPI AGCancers2072-66942024-03-01166118210.3390/cancers16061182Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-AnalysisMarco Tonello0Carola Cenzi1Elisa Pizzolato2Riccardo Fiscon3Paola Del Bianco4Pierluigi Pilati5Antonio Sommariva6Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalyClinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalySurgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalySurgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalyClinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalySurgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalySurgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, ItalyBackground. For patients with colorectal cancer (CRC) peritoneal metastases (PM) who are eligible for cytoreductive surgery (CRS), the indication and timing of systemic chemotherapy (SC) are still under debate. This study aims to analyze the role of pre, post or perioperative SC on the survival and surgical complications of patients treated with CRS-HIPEC. Methods. After a systematic search in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science and Embase, a meta-analysis was performed to compare postoperative complications, disease-free survival (DFS) and overall survival (OS) according to SC administration and timing. PROSPERO: CRD42023478977. Results. Of 1203 studies screened, 15 were included in the meta-analysis (4523 patients). Post-operative SC was associated with increased overall survival (post-SC vs. no post-SC: HR 0.81, <i>p</i> = 0.00001, I<sup>2</sup> = 0%; pre-SC vs. post-SC: HR 0.65, <i>p</i> = 0.01, I<sup>2</sup> = 28%), whereas SC (pre or post) or pre-SC compared to surgery alone was not (SC vs. no SC: <i>p</i> = 0.29, I<sup>2</sup> = 80%; pre-SC vs. no pre-SC: <i>p</i> = 0.59, I<sup>2</sup> = 58%). Similar results were seen for DFS. SC was not associated with an increased complication rate (<i>p</i> = 0.47, I<sup>2</sup> = 64%). Conclusions. Systemic chemotherapy administration in patients undergoing radical surgery for colorectal peritoneal metastases is associated with increased survival only in the adjuvant/post-operative setting. Considering the limitations of the included studies, further trials are needed to answer this unresolved question.https://www.mdpi.com/2072-6694/16/6/1182peritoneal metastases (PM)cytoreductive surgery (CRS)HIPECcolorectal cancersystemic chemotherapy (SC) |
| spellingShingle | Marco Tonello Carola Cenzi Elisa Pizzolato Riccardo Fiscon Paola Del Bianco Pierluigi Pilati Antonio Sommariva Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis Cancers peritoneal metastases (PM) cytoreductive surgery (CRS) HIPEC colorectal cancer systemic chemotherapy (SC) |
| title | Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis |
| title_full | Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis |
| title_fullStr | Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis |
| title_full_unstemmed | Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis |
| title_short | Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis |
| title_sort | systemic chemotherapy in colorectal peritoneal metastases treated with cytoreductive surgery systematic review and meta analysis |
| topic | peritoneal metastases (PM) cytoreductive surgery (CRS) HIPEC colorectal cancer systemic chemotherapy (SC) |
| url | https://www.mdpi.com/2072-6694/16/6/1182 |
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