Peritoneal surface disease from colorectal cancer

Comparison with the hepatic metastases surgical paradigm in optimally resected patients

Perry Shen, Kurt Thai, John H. Stewart, Russell Howerton, Brian W. Loggie, Gregory B. Russell, Edward A. Levine

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Surgical resection is the treatment of choice for colorectal hepatic metastases (HM). In contrast, metastatic disease to the peritoneum is treated with systemic therapy. We examined our experience with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal surface disease (PSD) compared with liver resection for HM. Methods: A review of prospective databases of colorectal cancer patients undergoing surgery for metastatic disease to the peritoneum or liver (1992-2005) was carried out. Results: One hundred and twenty-one patients underwent CS + IPHC and 101 patients underwent hepatic resection with median follow-up of 86 and 56 months, respectively. Fifty-five (45%) patients in the IPHC group had complete resection of all gross tumor. Ninety-five (94%) of the HM patients had negative surgical margins. Comparison of the R0/R1 PSD and margin-negative HM group demonstrated significant differences in age, performance status, and preoperative chemotherapy. The 1-, 3-, and 5-year overall survival for the R0/R1 PSD patients was 91, 48, and 26%; while it was 87, 59, and 34% for the HM patients (P = 0.32). Perioperative morbidity was 42% versus 34% (P = 0.38) and mortality was 5.5% versus 4.2% (P = 0.71) between the PSD and HM patients, respectively. Conclusion: R0/R1 resection during CS + IPHC compared with margin-negative hepatic resection demonstrated no significant difference in overall survival and for select patients should be considered a viable treatment option. Further studies to improve the resectability of PSD patients and define the role of neoadjuvant and adjuvant drug strategies are needed.

Original languageEnglish
Pages (from-to)3422-3432
Number of pages11
JournalAnnals of Surgical Oncology
Volume15
Issue number12
DOIs
StatePublished - Dec 2008

Fingerprint

Peritoneal Diseases
Colorectal Neoplasms
Neoplasm Metastasis
Liver
Drug Therapy
Peritoneum
Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Peritoneal surface disease from colorectal cancer : Comparison with the hepatic metastases surgical paradigm in optimally resected patients. / Shen, Perry; Thai, Kurt; Stewart, John H.; Howerton, Russell; Loggie, Brian W.; Russell, Gregory B.; Levine, Edward A.

In: Annals of Surgical Oncology, Vol. 15, No. 12, 12.2008, p. 3422-3432.

Research output: Contribution to journalArticle

Shen, Perry ; Thai, Kurt ; Stewart, John H. ; Howerton, Russell ; Loggie, Brian W. ; Russell, Gregory B. ; Levine, Edward A. / Peritoneal surface disease from colorectal cancer : Comparison with the hepatic metastases surgical paradigm in optimally resected patients. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 12. pp. 3422-3432.
@article{80550fe15ccb4293bb96d64caa6e8755,
title = "Peritoneal surface disease from colorectal cancer: Comparison with the hepatic metastases surgical paradigm in optimally resected patients",
abstract = "Background: Surgical resection is the treatment of choice for colorectal hepatic metastases (HM). In contrast, metastatic disease to the peritoneum is treated with systemic therapy. We examined our experience with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal surface disease (PSD) compared with liver resection for HM. Methods: A review of prospective databases of colorectal cancer patients undergoing surgery for metastatic disease to the peritoneum or liver (1992-2005) was carried out. Results: One hundred and twenty-one patients underwent CS + IPHC and 101 patients underwent hepatic resection with median follow-up of 86 and 56 months, respectively. Fifty-five (45{\%}) patients in the IPHC group had complete resection of all gross tumor. Ninety-five (94{\%}) of the HM patients had negative surgical margins. Comparison of the R0/R1 PSD and margin-negative HM group demonstrated significant differences in age, performance status, and preoperative chemotherapy. The 1-, 3-, and 5-year overall survival for the R0/R1 PSD patients was 91, 48, and 26{\%}; while it was 87, 59, and 34{\%} for the HM patients (P = 0.32). Perioperative morbidity was 42{\%} versus 34{\%} (P = 0.38) and mortality was 5.5{\%} versus 4.2{\%} (P = 0.71) between the PSD and HM patients, respectively. Conclusion: R0/R1 resection during CS + IPHC compared with margin-negative hepatic resection demonstrated no significant difference in overall survival and for select patients should be considered a viable treatment option. Further studies to improve the resectability of PSD patients and define the role of neoadjuvant and adjuvant drug strategies are needed.",
author = "Perry Shen and Kurt Thai and Stewart, {John H.} and Russell Howerton and Loggie, {Brian W.} and Russell, {Gregory B.} and Levine, {Edward A.}",
year = "2008",
month = "12",
doi = "10.1245/s10434-008-0127-4",
language = "English",
volume = "15",
pages = "3422--3432",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "12",

}

TY - JOUR

T1 - Peritoneal surface disease from colorectal cancer

T2 - Comparison with the hepatic metastases surgical paradigm in optimally resected patients

AU - Shen, Perry

AU - Thai, Kurt

AU - Stewart, John H.

AU - Howerton, Russell

AU - Loggie, Brian W.

AU - Russell, Gregory B.

AU - Levine, Edward A.

PY - 2008/12

Y1 - 2008/12

N2 - Background: Surgical resection is the treatment of choice for colorectal hepatic metastases (HM). In contrast, metastatic disease to the peritoneum is treated with systemic therapy. We examined our experience with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal surface disease (PSD) compared with liver resection for HM. Methods: A review of prospective databases of colorectal cancer patients undergoing surgery for metastatic disease to the peritoneum or liver (1992-2005) was carried out. Results: One hundred and twenty-one patients underwent CS + IPHC and 101 patients underwent hepatic resection with median follow-up of 86 and 56 months, respectively. Fifty-five (45%) patients in the IPHC group had complete resection of all gross tumor. Ninety-five (94%) of the HM patients had negative surgical margins. Comparison of the R0/R1 PSD and margin-negative HM group demonstrated significant differences in age, performance status, and preoperative chemotherapy. The 1-, 3-, and 5-year overall survival for the R0/R1 PSD patients was 91, 48, and 26%; while it was 87, 59, and 34% for the HM patients (P = 0.32). Perioperative morbidity was 42% versus 34% (P = 0.38) and mortality was 5.5% versus 4.2% (P = 0.71) between the PSD and HM patients, respectively. Conclusion: R0/R1 resection during CS + IPHC compared with margin-negative hepatic resection demonstrated no significant difference in overall survival and for select patients should be considered a viable treatment option. Further studies to improve the resectability of PSD patients and define the role of neoadjuvant and adjuvant drug strategies are needed.

AB - Background: Surgical resection is the treatment of choice for colorectal hepatic metastases (HM). In contrast, metastatic disease to the peritoneum is treated with systemic therapy. We examined our experience with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal surface disease (PSD) compared with liver resection for HM. Methods: A review of prospective databases of colorectal cancer patients undergoing surgery for metastatic disease to the peritoneum or liver (1992-2005) was carried out. Results: One hundred and twenty-one patients underwent CS + IPHC and 101 patients underwent hepatic resection with median follow-up of 86 and 56 months, respectively. Fifty-five (45%) patients in the IPHC group had complete resection of all gross tumor. Ninety-five (94%) of the HM patients had negative surgical margins. Comparison of the R0/R1 PSD and margin-negative HM group demonstrated significant differences in age, performance status, and preoperative chemotherapy. The 1-, 3-, and 5-year overall survival for the R0/R1 PSD patients was 91, 48, and 26%; while it was 87, 59, and 34% for the HM patients (P = 0.32). Perioperative morbidity was 42% versus 34% (P = 0.38) and mortality was 5.5% versus 4.2% (P = 0.71) between the PSD and HM patients, respectively. Conclusion: R0/R1 resection during CS + IPHC compared with margin-negative hepatic resection demonstrated no significant difference in overall survival and for select patients should be considered a viable treatment option. Further studies to improve the resectability of PSD patients and define the role of neoadjuvant and adjuvant drug strategies are needed.

UR - http://www.scopus.com/inward/record.url?scp=58149290056&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149290056&partnerID=8YFLogxK

U2 - 10.1245/s10434-008-0127-4

DO - 10.1245/s10434-008-0127-4

M3 - Article

VL - 15

SP - 3422

EP - 3432

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 12

ER -