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Peritoneal Surface Malignancies

E354: Long-term outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin.

Introduction: Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) is a major modality in the treatment of colorectal peritoneal carcinomatosis (CPC). The aim of this study was to determine the 2-year and 5-year disease-free survival (DFS) and overall survival (OS) of patients undergoing CRS-HIPEC for CPC and factors associated with improved survival.

Methods: All consecutive patients with CPC who underwent CRS-HIPEC were identified within  a HIPEC centre between 2007-2021. Data on patient characteristics, treatment patterns, postoperative morbidity, recurrence, and survival were collected. Actuarial survival was calculated using Kaplan-Meier curves and true 2-year and 5-year OS and DFS were calculated. Cox proportional hazards models were used to identify factors associated with OS and DFS.

Results: There were 125 patients identified with CPC who underwent CRS-HIPEC between 2007-2021, with mean age of 54.5 years (23.5-76.1). The median follow-up was 30.6 months (5-195). The average intraoperative PCI was 11 (0-39), and complete cytoreduction (CC-0) was possible in 121 patients (96.8%). The majority of patients (79.2%) received preoperative systemic chemotherapy. The median survival was 32 months (5-193). The 2-year and 5-year OS were 68% and 24.8%, respectively, while the DFS at 2-year was 28.8% and at 5-year 14.4%. Factors associated with worse OS included pre-HIPEC systemic therapy, synchronous extra-peritoneal metastasis and PCI >20 (p< 0.05). Pre-HIPEC systemic therapy and progression of disease prior to CRS/HIPEC were associated with worse DFS (p< 0.05). Origin of cancer, nodal status, synchronous peritoneal disease, and receiving systemic therapy postoperatively were not statistically significant.

Conclusions: CRS and HIPEC can offer improved 2- and 5-year OS in patients with CPC, however, it remains a challenging entity with high recurrence rate. The use and response to preoperative systemic therapy and the presence of extra-peritoneal synchronous metastasis can help predict outcomes.

Learning Objectives:

  • 1. Upon completion, participant will be able to evaluate the 5-year and 2-year overall survival and disease free survival in patients with colorectal peritoneal metastasis undergoing CRS-HIPEC.
  • 2. Upon completion, participant will be able to identify factors associated with improved and worse overall survival in patients undergoing CRS-HIPEC for colorectal peritoneal carcinomatosis.
  • 3. Upon completion, participant will be able to identify factors associated with improved and worse disease free survival in patients undergoing CRS-HIPEC for colorectal peritoneal carcinomatosis.