Influence of Extraperitoneal Metastases on the Curative-Intent Management of Colorectal Peritoneal Metastases

Background Selected patients with colorectal cancer peritoneal metastasis (CRPM) and extraperitoneal disease could be treated radically with a multimodal approach combining complete cytoreductive surgery, thermoablation, radiotherapy, and systemic and intraperitoneal chemotherapy. The impact of extr...

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Vydáno v:Annals of surgical oncology Ročník 30; číslo 7; s. 4444 - 4454
Hlavní autoři: Schell, Frédéric, Kefleyesus, Amaniel, Benzerdjeb, Nazim, Passot, Guillaume, Rousset, Pascal, Omar, Alhadeedi, Villeneuve, Laurent, Péron, Julien, Glehen, Olivier, Kepenekian, Vahan
Médium: Journal Article
Jazyk:angličtina
Vydáno: Cham Springer International Publishing 01.07.2023
Springer Nature B.V
Témata:
Chemotherapy
Colorectal cancer
Colorectal carcinoma
Gastric cancer
Liver
Lung cancer
Lymph nodes
Medical prognosis
Medicine
Medicine & Public Health
Metastases
Metastasis
Multivariate analysis
Oncology
Peritoneal diseases
Peritoneal Surface Malignancy
Peritoneum
Radiation therapy
Surgery
Surgical Oncology
ISSN:1068-9265, 1534-4681, 1534-4681
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Shrnutí:Background Selected patients with colorectal cancer peritoneal metastasis (CRPM) and extraperitoneal disease could be treated radically with a multimodal approach combining complete cytoreductive surgery, thermoablation, radiotherapy, and systemic and intraperitoneal chemotherapy. The impact of extraperitoneal metastatic sites (EPMS) in this setting remains unclear. Patients and Methods Patients with CRPM undergoing complete cytoreduction in 2005–2018 were grouped in: peritoneal disease only (PDO), one EPMS (1 + EPMS), two or more EPMS (2 + EPMS). A retrospective analysis compared overall survival (OS) and postoperative outcomes. Results Of 433 patients, 109 had 1 + EPMS and 31 had 2 + EPMS. Overall, 101 patients had liver metastasis, 19 lung metastasis, and 30 retroperitoneal lymph node (RLN) invasion. The median OS was 56.9 months. There was no significant OS difference between PDO and 1 + EPMS groups (64.6 and 57.9 months, respectively), whereas OS was lower in the 2 + EPMS group (29.4 months, p  = 0.005). In multivariate analysis, 2 + EPMS [hazard ratio (HR) 2.86, 95% confidence interval (CI) 1.33–6.12, p = 0.007], Sugarbaker’s Peritoneal Carcinomatosis Index (PCI) > 15 (HR 3.86, 95% CI 2.04–7.32, p  < 0.001), poorly differentiated tumors (HR 2.62, 95% CI 1.21–5.66, p = 0.015), and BRAF mutation (HR 2.10, 95% CI 1.11–3.99, p = 0.024) were independent poor prognostic factors, while adjuvant chemotherapy was beneficial (HR 0.33, 95% CI 0.20–0.56, p < 0.001). Patients with liver resection did not show higher severe complication rates. Conclusion In patients with CRPM selected for a radical surgical approach, limited extraperitoneal disease involving one site, notably the liver, does not seem to significantly impair postoperative results. RLN invasion appeared as a poor prognostic factor in this population.
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ISSN:1068-9265
1534-4681
1534-4681
DOI:10.1245/s10434-023-13279-9