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Peritoneal Surface Malignancies

E348: Neoadjuvant Chemotherapy Prior to Cytoreductive Surgery and Heated Intraperitoneal Chemoperfusion for Patients with Metachronous Colorectal Peritoneal Metastases: Experience at a High Volume Center

Introduction: Neoadjuvant chemotherapy (NACT) prior to Cytoreductive Surgery and Heated Intraperitoneal Chemoperfusion (CRS/HIPEC) for patients with metachronous colorectal cancer peritoneal metastases (CRPM) carries theoretical advantages however thus far has not demonstrated survival benefit.

Methods: We conducted a retrospective single institution study of patients with CRPM with no evidence of extraabdominal disease undergoing CRS/HIPEC +/- NACT from 2002 to 2022. NACT was administered with the intent of eventual resection and finished within 3 months prior to operation. Survival was measured from date of CRPM diagnosis.

Results: A total of 211 patients with metachronous CRPM were identified. 134 patients (63.5%)  underwent NACT during the study period while 77 patients (36.5%) underwent upfront CRS/HIPEC. Of patients undergoing NACT, only 2 (1.5%) did not eventually undergo CRS/HIPEC secondary to disease progression.  23 of 77 patients (29.9%) undergoing upfront CRS/HIPEC eventually underwent postoperative adjuvant chemotherapy. The majority of patients in the cohort were white (91.9%) and male (52.1%) with a mean age of  57yrs. Poorly differentiated histology was noted in 43pts (20.4%) with lymph node metastases noted in 120 pts(67.0%). 155 pts (73.5%) had undergone previous systemic chemotherapy in their disease course prior to development of CRPM. The mean PCI of the cohort was 12.4 and the majority of patients underwent complete cytoreduction (CC0:178, 85.6%). Patients who received NACT demonstrated no difference in PCI (12.8 vs 11.7, p=.25) or undergoing complete cytoreduction (82.8% vs 90.5% p=.13) versus those who underwent upfront CRS/HIPEC. Disease progression observed during NACT did not impact eventual survival after surgery (p=.37). Patients undergoing NACT+CRS/HIPEC did not show a significant difference in 30 day rates of major complications (10.4% vs 8.1%, p=.58) or mortality (2.3% vs 1.4%, p=.64) There was no significant difference in median RFS (17.8 vs 24.4 months, p=.25) or OS (35.3 vs 33.7 months, p=.47, Figure 1) between those undergoing NACT vs upfront CRS/HIPEC.

Conclusions: Utilizing NACT prior to CRS/HIPEC for patients with metachronous CRPM did not demonstrate a difference in PCI encountered at operation, ability to obtain complete cytoreduction, complication rate, or long term survival. Further studies are needed to better evaluate the optimal role and timing of systemic chemotherapy in this patient population.

Learning Objectives:

  • Upon completion, participants will be able to describe the relationship of PCI and CC scores related to neoadjuvant chemotherapy for CRPM treated with CRS/HIPEC.
  • Upon completion, participants will be able to describe complication rates related to neoadjuvant chemotherapy for CRPM treated with CRS/HIPEC.
  • Upon completion, participants will be able to describe survival related to neoadjuvant chemotherapy for CRPM treated with CRS/HIPEC.