Resident The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer Ramat Gan, United States
Background: While peritoneal carcinomatosis index (PCI) is a commonly used tool in assessing early and long-term outcomes of patients with peritoneal recurrence of colon cancer, the relation between surgical approach of the index colectomy and prognosis hasn’t been studied. We aimed to compare the outcomes and the location of peritoneal metastasis (PM) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between patients who primarily underwent an open colectomy vs. laparoscopic colectomy.
Methods: Patients who underwent CRS/HIPEC for colorectal cancer with peritoneal metastases from 2015-2022 were identified from a prospectively maintained database of peritoneal surface malignancies and were divided into two groups according to the primary colectomy approach, open or laparoscopic colectomy. Operative and 30-day outcomes were compared between groups, as well as long-term survival outcomes.
Results: 159 patients were identified of which 101 patients were in the open group and 58 patients in the laparoscopic group. Both groups were similar with respect to age, gender and co-morbidities. TNM staging was similar in between groups as well as PCI score; however, there was more upper jejunal disease involvement in the laparoscopic group and shorter duration of CRS/HIPEC. In a multivariable analysis, laparoscopic colectomy patients had a longer disease-free survival vs open colectomies (26 months vs 10 months).
Discussion: Performing CRS HIPEC after laparoscopic colectomy is associated with longer disease-free survival. Additionally, a trend of more proximal disease location was observed.
