Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Colorectal Cancer with Peritoneal Metastasis: A Single-Center Cohort Study

TL;DR

This study shows that combining surgery with heated chemotherapy improves survival for colorectal cancer patients with peritoneal metastasis.

Contribution

The study confirms the effectiveness of CRS + HIPEC using entropy balance and a single-center cohort.

Findings

Median overall survival was 47 months with high 1-, 3-, and 5-year survival rates.

Complete cytoreduction (CCS ≤ 1) is critical for best survival outcomes.

PCI > 6 is a key prognostic factor for survival in these patients.

Abstract

Multimodal treatment in peritoneal metastases (PM) from colorectal neoplasms may improve overall survival (OS). In this study, we reported our experience in using cytoreductive surgery (CRS) combined with intraperitoneal chemohyperthermia (HIPEC) for the treatment of peritoneal metastases (PM) from colorectal neoplasms. The first aim was to evaluate the overall survival of these patients. Furthermore, using the results of the Prodige 7 Trial and incorporating them with the entropy balance statistical tool, we generated a pseudopopulation on which to test the use of CRS alone. We performed a retrospective analysis based on a prospective database of all 55 patients treated with CRS + HIPEC between March 2004 and January 2023. The median OS was 47 months, with 1-, 3- and 5-year survival rates of 90.8%, 58.7% and 42.7%, respectively. There was no significant difference in the data in the pseudogroup generated with entropy balance. This finding confirms the critical role of complete cytoreduction in achieving the best OS for patients with PM. PCI > 6 seems to be the most important prognostic factor influencing OS. At present, CRS + HIPEC seems to be the therapeutic strategy that guarantees the best results in terms of OS for patients with relatively low PCI and in whom a CCS ≤ 1 can be achieved.

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