Neoadjuvant Chemotherapy with Bevacizumab May Improve Outcome after Cytoreduction and Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) for Colorectal Carcinomatosis 8-Year Follow-up of Randomized Trial: Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy Versus Systemic Chemotherapy in Patients with Peritoneal Carcinomatosis of Colorectal Cancer Aggressive Surgical Management of Peritoneal Carcinomatosis With Low Mortality in a High-Volume Tertiary Cancer Center Prospective, randomized trial of intravenous versus intraperitoneal 5-fluorouracil in patients with advanced primary colon or rectal cancer. Impact of peritoneal carcinomatosis in the disease history of colorectal cancer management: a longitudinal experience of 2406 patients over two decades Cytoreduction and heated intraperitoneal chemotherapy for colorectal cancer: are we excluding patients who may benefit? 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Background In selected patients with colorectal peritoneal carcinomatosis ( PC ) , cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemoperfusion ( HIPEC ) may improve survival . We aim ed to assess whether neoadjuvant chemotherapy with or without bevacizumab is indicated in this patient population . Methods Colorectal PC patients were treated with CRS and HIPEC using oxaliplatin ( 200–460 mg/m2 ) or mitomycin C ( 35 mg/m2 ) . Postoperative outcome and long-term survival were prospect ively recorded . The impact of clinical variables on overall survival ( OS ) was assessed using univariate and Cox multivariate analysis . Results Between October 2002 and May 2012 , 166 patients were treated with CRS and HIPEC . Neoadjuvant chemotherapy alone was administered to 21 % and neoadjuvant chemotherapy with bevacizumab to 16 % of patients . Postoperative mortality and major morbidity were 2.4 and 35 % , respectively . Half of the patients received adjuvant chemotherapy . After a median follow-up of 18 months , OS was 27 months ( 95 % confidence interval 20.8–33.2 ) . On univariate analysis , OS was associated with extent of disease ( P < 0.001 ) , neoadjuvant chemotherapy with bevacizumab ( P = 0.021 ) , completeness of cytoreduction ( CC ) ( P < 0.001 ) , and adjuvant chemotherapy ( P = 0.04 ) , but not with primary disease site , synchronous presentation , or chemoperfusion drug . In multivariate Cox regression , independent predictors of OS were CC ( hazard ratio 0.29 , P < 0.001 ) and neoadjuvant therapy containing bevacizumab ( hazard ratio 0.31 , P = 0.019 ) . Conclusions Long-term OS after CRS and HIPEC for colorectal cancer is associated with CC and neoadjuvant therapy containing bevacizumab . This regimen merits prospect i ve study in patients with resectable PC of colorectal origin Introduction The treatment of peritoneal carcinomatosis is based on cytoreduction followed by hyperthermic intraperitoneal chemotherapy and combined with adjuvant chemotherapy . In 2003 , a r and omized trial was finished comparing systemic chemotherapy alone with cytoreduction followed by hyperthermic intraperitoneal chemotherapy and systemic chemotherapy . This trial showed a positive result favoring the studied treatment . This trial has now been up date d to a minimal follow-up of 6 years to show long-term results . Patients and Methods For all patients still alive , the follow-up was up date d until 2007 . In the original study , four patients were excluded — two because of no eligible histology/pathology and two because of major protocol violations . After r and omization , four patients in the HIPEC arm and six in the control arm were not treated using the intended therapy , one patient because of withdrawal , one because of a life-threatening other malignant disease and the others because of progressive disease before initiation of the treatment . During the follow-up , one patient was crossed over from the control arm and underwent cytoreduction and HIPEC for recurrent disease , after the assigned treatment was completed . The data from these patients were censored at the moment of the cross-over . Progression-free and disease-specific survival were analyzed using the Kaplan Meyer test and compared using the log rank method . The long-term results were studied in more detail to evaluate efficacy and toxicity . Results At the time of this up date , the median follow-up was almost 8 years ( range 72–115 months ) . In the st and ard arm , 4 patients were still alive , 2 with and 2 without disease ; in the “ HIPEC ’ arm , 5 patients were still alive , 2 with and 3 without disease . The median progression-free survival was 7.7 months in the control arm and 12.6 months in the HIPEC arm ( P = 0.020 ) . The median disease-specific survival was 12.6 months in the control arm and 22.2 months in the HIPEC arm ( P = 0.028 ) . The 5-year survival was 45 % for those patients in whom a R1 resection was achieved . Conclusion With 90 % of all events having taken place up to this time , this r and omized trial shows that cytoreduction followed by HIPEC does significantly add survival time to patients affected by peritoneal carcinomatosis of colorectal origin . For a selected group , there is a possibility of long-term survival Background Cytoreductive surgery ( CS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for treatment of peritoneal carcinomatosis ( PC ) traditionally involves high perioperative morbidity and mortality . We report our experience performing CS-HIPEC in a high-volume regional perfusion program design ed to limit morbidity and mortality . Methods A total of 122 patients underwent 124 CS-HIPEC procedures . Common tumors treated with CS-HIPEC included appendiceal ( 38.5 % ) , colorectal ( 24.6 % ) , and ovarian cancers ( 13.1 % ) , and peritoneal mesothelioma ( 12.3 % ) . Complete cytoreduction was performed in all patients , with organ resections performed as necessary . Results R0 resection was achieved in 28.7 % of cases , R1 in 54.9 % , and R2 in 16.4 % . Median operative time was 460 minutes ( range , 250–840 minutes ) , and median blood loss was 1150 mL ( range , 10–14,000 mL ) . Median hospital and intensive care unit stays were 12 days ( range , 6–50 days ) and 3 days ( range , 0–41 days ) , respectively . Grade 3 or 4 morbidity by National Cancer Institute criteria ( major morbidity ) was seen in 29.8 % of cases , with overall morbidity 56.5 % . Independent prognostic variables for major morbidity included number of anastomoses and degree of cytoreduction . In-hospital and 30-day mortality rates were 0 % and 1.6 % , respectively . The most favorable diagnosis was appendiceal cancer , for which 2-year survival was 66.7 % , with lower- grade histologic subtypes of appendiceal cancer reaching 85.7 % 2-year survival . Colorectal cancer had 2-year survival of 36.7 % . Conclusions In a high-volume center with extensive experience treating peritoneal malignancies , perioperative mortality can be lowered to nearly zero , although morbidity remains high . CS-HIPEC procedures should be studied further in a controlled manner to help define their important role in the care of patients with PC No new chemotherapy agents have been developed recently that present hope for improving survival in patients with colon or rectal cancer . We undertook this study to investigate a new route of administering an old drug , 5-fluorouracil ( 5-FU ) .  Sixty-six patients with advanced primary colon or rectal cancer were r and omized to receive 12 cycles with increasing dosages of intravenous ( IV ) or intraperitoneal ( IP ) 5-FU ; the mean follow-up time was three years . The maximal tolerable dose and objective adverse side effects were prospect ively recorded . The mean daily dose of 5-FU given by the IV route was 904 mg ; for the IP route it was 1361 mg ( p2 less than 0.0001 ) . Two of ten patients had recurrent peritoneal carcinomatosis when treated with IP 5-FU ; ten of eleven patients treated with IV 5-FU developed peritoneal implants ( p2 less than 0.003 ) . The incidence of serious complications was the same , but hematologic toxicity and hepatic toxicity were significantly reduced in patients who received IP 5-FU . When 5-FU is delivered by the IP route , the tolerable dose of drug was markedly increased without an increase in adverse side effects . The natural history of surgically treated disease was changed by reducing the incidence of peritoneal carcinomatosis but time to relapse and survival was not improved . IP 5-FU may be recommended for investigation in patients with perforated colon cancer , peritoneal implants , or as one part of a multimodality treatment protocol for colorectal cancer . If 5-FU is given to patients with gastrointestinal malignancy , the IP route should be strongly considered Background : Recent therapeutic developments dem and for an up date of information on natural history , risk factors and prognosis of peritoneal carcinomatosis ( PC ) of colorectal origin . Therefore , prospect i ve registry data should provide information about incidence , predictors and outcome . Methods : From a prospect ively exp and ed single-institutional data base with 2406 consecutive patients with colorectal cancer ( CRC ) , clinical , histological and survival data were analysed for independent risk factors and prognosis . Findings were then stratified to the era of treatment without chemotherapy , 5-Fluorouracil-only and contemporary systemic chemotherapy , respectively . Results : Overall , 256 ( 10.6 % ) patients were diagnosed with PC thereof 141 ( 5.85 % ) with metachronous PC . Independent risk factors for the development of metachronous PC were age < 62 years , N2-status , T4-status , location of the primary in the left colon or appendix . In the era of contemporary systemic chemotherapy , prognosis for PC improved only not-significantly ( median survival of 17.9 months vs 7.03 months , P=0.054 ) . Conclusion : Despite improvement in the overall outcome with prolonged median survival for the complete patient cohort with CRC , those patients with PC have not experienced the same benefit . In the era of contemporary systemic chemotherapy , progress in treatment result ed in only limited survival benefit . Thus , continuous efforts for further therapeutic advancements should be undertaken in these patients diagnosed with PC BACKGROUND Cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) are increasingly used to treat peritoneal carcinomatosis from colorectal cancer . It is still relatively unknown which poor prognostic factors to avoid in order to optimize patient selection for CRS + HIPEC . METHODS Between February 2003 and October 2011 , 68 consecutive colorectal cancer patients who underwent CRS + HIPEC with a complete cytoreduction were identified from a prospect i ve data base .  Survival analysis was performed using the Kaplan-Meier method , with log rank testing of differences between groups . Multivariate analysis was conducted using Cox proportional hazard regression . RESULTS Median follow-up was 30.3 ( range , 2 - 88 ) months amongst survivors . Patients with a peritoneal cancer index ( PCI ) of 10 or less showed improved survival over those with a PCI of 11 or higher ( P = 0.03 ) . No difference in survival was seen for the other potentially poor prognostic variables including lymph node status , synchronous peritoneal disease , peri-operative systemic chemotherapy , and rectal cancer primary . CONCLUSIONS A low PCI was associated with improved survival .  Complete CRS + HIPEC appears to result in similar survival outcomes regardless of delivery of peri-operative systemic chemotherapy . Rectal origin , lymph node status , and synchronous peritoneal disease should not be used as an absolute exclusion criteria for CRS + HIPEC based on current data Purpose This nationwide study evaluated results of cytoreductive surgery ( CRS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for peritoneal metastasis of colorectal origin in the Netherl and s following a national protocol . Methods In a multi-institutional study prospect i ve data bases of patients with peritoneal carcinomatosis ( PC ) from colorectal cancer and pseudomyxoma peritonei ( PMP ) treated according to the Dutch HIPEC protocol , a uniform approach for the CRS and HIPEC treatment , were review ed . Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival . Results Nine-hundred sixty patients were included ; 660 patients ( 69 % ) were affected by PC of colorectal carcinoma and the remaining suffered from PMP ( 31 % ) . In 767 procedures ( 80 % ) , macroscopic complete cytoreduction was achieved . Three-hundred and thirty one patients had grade III – V complications ( 34 % ) . Thirty-two patients died perioperatively ( 3 % ) . Median length of hospital stay was 16 days ( range 0–166 days ) . Median follow-up period was 41 months ( 95 % confidence interval ( CI ) , 36–46 months ) . Median progression-free survival was 15 months ( 95 % CI 13–17 months ) for CRC patients and 53 months ( 95 % CI 40–66 months ) for PMP patients . Overall median survival was 33 ( 95 % CI 28–38 months ) months for CRC patients and 130 months ( 95 % CI 98–162 months ) for PMP patients . Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients . Conclusions The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP . It is assumed the uniform Dutch HIPEC protocol was beneficial Background Cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemoperfusion ( HIPEC ) for peritoneal carcinomatosis ( PC ) of colorectal origin increases survival ( OS ) compared to systemic chemotherapy alone . Signet ring histology demonstrates aggressive behavior with poor survival . We sought to determine whether CRS/HIPEC increases survival in this subset of patients . Methods We review ed 67 patients with PC of appendiceal ( AP , n = 37 ) or colorectal origin ( CRC , n = 30 ) with signet cell histology from a prospect i ve data base between May 2001 and August 2011 .  Survival analysis and multivariate Cox regression were used to determine prognostic factors for survival . Results Complete CRS ( CC-0/1 ) was achieved in 77 % ( CRC ) and 73 % ( AP ) of patients . Progression-free survival ( PFS ) and OS were 9 and 12 months in CRC and 12 and 21 months in AP patients . In the CRC group , univariate predictors of poor survival included female gender , age , American Society of Anesthesiologists score , preoperative albumin , completeness of cytoreduction , and morbidity . In a multivariate Cox regression model , incomplete cytoreduction ( CC-2/3 ) and female gender were joint significant predictors of poor survival . In the AP group , significant univariate predictors of poor survival included higher EBL and PCI score . In a multivariate Cox regression model , blood loss of > 500 ml and a body mass index of < 25 kg/m2 were joint significant predictors of poor survival . Conclusions AP signet cell tumors demonstrate a more favorable outcome than CRC signet cell tumors after CRC/HIPEC for carcinomatosis , suggesting an underlying difference in biology . CRS/HIPEC does not confer survival benefit in colorectal signet ring carcinomatosis unless complete cytoreduction can be achieved , whereas appendiceal signet ring carcinomatosis may benefit , regardless of resectability Abstract Background : Hyperthermic intraoperative intraperitoneal chemotherapy ( HIIC ) has been recently proposed to treat peritoneal carcinomatosis arising from colon adenocarcinoma , which is usually regarded as a lethal clinical entity . The purpose of this study was to evaluate the clinical outcome of this combined treatment . Methods : A retrospective study of 46 patients treated for peritoneal carcinomatosis from colon adenocarcinoma was performed . Thirty-four patients were treated with complete cytoreductive surgery immediately followed by intraoperative HIIC with mitomycin C and cisplatin . The clinical outcome of these 34 patients was analyzed ; the median follow-up period was 14.5 months . Results : No postoperative deaths were reported . The postoperative morbidity rate was 35 % . No severe locoregional or systemic toxicity was observed . The 2-year overall survival was 31 % , and the median survival time and the median time to local disease progression were 18 and 13 months , respectively . Survival and local disease control in patients with well- and moderately differentiated colon adenocarcinoma were significantly better than in those with poorly differentiated tumors . Conclusions : Considering the dismal prognosis of this condition , HIIC seems to achieve encouraging results in a selected group of patients affected with resectable peritoneal carcinomatosis arising from colon adenocarcinoma . These findings support the conduction of formal phase III r and omized trials Background Chemohyperthermic peritoneal perfusion ( CHPP ) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis ( PC ) . The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and /or chemotherapeutic treatment was 5.2 months . Historically , mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer . Methods Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and /or surgical treatment ( 24 patients ) were enrolled . Immediately following extensive cytoreductive surgery , early postoperative closed abdomen CHPP was performed . Results Complete surgical cytoreduction ( CC0–CC1 ) was obtained in 22 patients . Postoperative mortality was 1 out of 25 ( 4 % ) . Major postoperative morbidity was 6 out of 25 ( 24 % ) . Median overall survival estimated by Kaplan – Meier curve was 30.3 months . Locoregional progression-free survival was 17.3 months . Of all the patients 64 % and 40 % were alive after 1 and 2 years respectively . Conclusions In referral centers CHPP after optimal surgical debulking is a safe procedure for peritoneal carcinomatosis from colonic cancer . Locoregional control was obtained in the majority of the pretreated patients and 1-year survival was statistically improved . A closed abdomen CHPP procedure lasting 1 hour and st and ard mitomycin C at a dosage of 15 mg/m2 is probably as efficacious as other hyperthermic procedures , using higher mitomycin C dosages , with a comparable or lower number of cases of side effects . These results , as in other published phase II studies , justify future r and omized trials to assess definitively the role of CHPP in the treatment of locally advanced colon neoplasms in western countries BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy ( CRS-HIPEC ) is the preferred treatment of peritoneal carcinomatosis ( PC ) of colorectal carcinoma . Patients with positive lymph node status have worse survival after CRS-HIPEC , which is probably due to higher rates of systemic failure . In this study , we analysed the effect of administration and timing of systemic chemotherapy on the outcome of lymph node positive colorectal carcinoma patients treated with CRS-HIPEC .  PATIENTS AND METHODS A prospect i ve data base was review ed to identify lymph node positive patients with PC treated with CRS-HIPEC within 1 year after primary tumour diagnosis between 2004 and 2012 . Medical history of the patients was studied for the administration of perioperative systemic chemotherapy and follow-up . Outcome parameters were progression-free survival ( PFS ) , overall survival ( OS ) and pattern of recurrence . RESULTS Seventy-three patients treated with CRS-HIPEC for PC from lymph node positive colorectal carcinoma were identified . Fourteen patients received  pre-CRS-HIPEC chemotherapy only , 32 patients underwent post-CRS-HIPEC chemotherapy only , 9 patients received chemotherapy both pre- and post-CRS-HIPEC and 16 patients did not receive any systemic chemotherapy . Of the 47 patients who did not receive pre-CRS-HIPEC chemotherapy , 11 ( 23 % ) did not receive any chemotherapy due to major postoperative complications . PFS and OS were significantly higher in patients who received systemic chemotherapy ( PFS : median 15 versus 4 months , P = 0.024 ; OS : median 30 versus 14 months , P = 0.015 ) , although this difference was attenuated after adjustment for major complications . Different chemotherapy timings did not differ significantly in either survival or recurrence patterns . CONCLUSIONS In patients with PC from lymph node positive colorectal carcinoma , perioperative systemic chemotherapy is associated with increased OS and PFS , although this difference may be partly explained by the occurrence of major postoperative complication ; with no evidence of difference in PFS , OS and systemic recurrence rate by timing of systemic chemotherapy Background Cytoreductive surgery ( CS ) with hyperthermic intraperitoneal chemotherapy ( HIPEC ) is the treatment most likely to achieve prolonged survival in peritoneal carcinomatosis ( PC ) . Yet the efficacy of HIPEC in rectal patients is controversial because of the retroperitoneal location of the primary tumor . Therefore , we review ed our experience in patients with PC from a rectal primary tumor . Methods A retrospective analysis of a prospect i ve data base of 950 HIPEC procedures was performed . Performance status , age , albumin level , prior surgical score , resection status , morbidity , mortality , and survival were review ed . Results A total of 13 and 204 patients with PC from rectal and colon cancer , respectively , were identified . Median follow-up was 40.1 and 88.1 months , respectively . Eastern Cooperative Oncology Group ( ECOG ) score was zero or one for 92 % of patients with rectal cancer and 83 % for colon , while R1 resection was achieved in 54 and 51 % . The 30-day mortality was 5 % for colon cancer . There were no deaths in the rectal group . The morbidity for the colon and rectal groups was 57 and 46 % , respectively , with a 23 % 30-day readmission rate . In univariate analysis , age , ECOG , prior surgical score , albumin level , and node and resection status were not statistically significant in predicting survival for the rectal cancer patients .  Median survival for the rectal and colon groups was 14.6 versus 17.3 months , while the 3-year survival was 28.2 versus 25.1 % . Conclusions Our data demonstrate similar 3-year survival for patients with rectal and colon cancer PC treated with CS/HIPEC . This can be attributed to patient selection bias . Selected rectal cancer PC patients should not be excluded from an attempted cytoreduction and HIPEC OBJECTIVE To review our 25-year experience with hyperthermic intra-peritoneal chemotherapy ( HIPEC ) . BACKGROUND Combining cytoreductive surgery ( CRS ) and HIPEC as local treatments for peritoneal carcinomatosis ( PC ) was proposed 25 years ago . METHODS A prospect i ve data base of all patients undergoing HIPEC for PC since 1989 was search ed for clinicopathological data , 90-day morbidity and mortality , and survival . RESULTS Among 1,125 HIPEC procedures , PC origin was colorectal ( 342 ; 30 % ) , ovarian ( 271 ; 24 % ) , pseudomyxoma peritonei ( 189 ; 17 % ) , gastric ( 127 ; 11 % ) , malignant mesothelioma ( 84 ; 8 % ) , or other ( 112 ; 10 % ) . Between 2004 - 2009 ( n = 321 ) and 2010 - 2015 ( n = 560 ) , the median peritoneal cancer index decreased ( 11 vs. 8 ; P < 0.001 ) , fewer patients underwent incomplete cytoreduction ( CC2 - 3 : 4 % vs. 0.5 % ; P < 0.001 ) , and more were included in r and omized trials ( 5 % vs. 16 % ; P < 0.001 ) . Postoperative morbidity ( 52 % vs. 50 % , P = 0.672 ) was not different , but mortality significantly decreased ( 5 % vs. 2 % ; P = 0.030 ) . Median overall-survival was 42 months , and improved significantly for each 5-year period except for 2006 - 2010 vs. 2011 - 2015 ( P = 0.097 ) . The 10-year survival without recurrence was 53 % , 14 % , 4 % , 10 % , and 9 % for pseudomyxoma , mesothelioma , ovarian , colorectal , and gastric PC , respectively . CONCLUSION This study demonstrated that CRS and HIPEC provide long-term survival irrespective of PC origin , and survival improves with experience . J. Surg . Oncol . 2016;113:796 - 803 . © 2016 Wiley Periodicals , Background Colorectal peritoneal carcinomatosis ( PC ) is a frequent and very lethal event . However , cure may be possible with maximal cytoreductive surgery associated with early postoperative intraperitoneal chemotherapy ( EPIC ) . Methods Between 1996 and 2000 , we conducted a two-center prospect i ve r and omized trial comparing EPIC plus systemic chemotherapy with systemic chemotherapy alone , both after  complete cytoreductive surgery of colorectal PC . Only 35 patients could be included among the 90 who were theoretically required , mainly because of patient dissatisfaction with the inclusion criteria . For this reason , the trial was stopped prematurely . Results Analysis of these 35 patients showed that complete resection of PC result ed in a 2-year survival rate of 60%—far above the classic 10 % survival rate among patients with colorectal PC treated with systemic  chemotherapy  and symptomatic surgery . In this small series , EPIC did not demonstrate any advantage for survival . Conclusions This supports the use of complete cytoreductive surgery in selected patients and calls for a prospect i ve r and omized trial comparing adjuvant systemic chemotherapy with intraperitoneal chemohyperthermia after complete resection Most patients with peritoneal carcinomatosis of digestive tract origin die within 6 months . Intraperitoneal chemohyperthermia ( IPCH ) associated with surgery has been reported as a possible new therapeutic approach Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant to systemic chemotherapy . We performed a phase I/II trial to investigate the feasibility and effectiveness of extensive cytoreductive surgery in combination with intra-operative hyperthermic intraperitoneal chemotherapy ( HIPEC ) in these patients . 29 patients with peritoneal carcinomatosis of colorectal origin without evidence of distant metastases underwent cytoreductive surgery and intra-operative HIPEC with mitomycin-C ( MMC ) , followed by systemic chemotherapy with 5-fluorouracil (5-FU)/leucovorin .  Surgical complications occurred in 11 patients ( 38 % ) . One patient died directly related to the treatment , result ing in a mortality rate of 3 % . MMC toxicity existed mainly of leucocytopenia ( in 15 patients ; 52 % ) . After a median follow-up of 38 months ( range 26 - 52 months ) we found a 2- and 3-year survival rate ( Kaplan-Meier ) of 45 and 23 % , respectively . Extensive cytoreductive surgery and HIPEC is feasible in patients with peritoneal seeding of colorectal cancer . First results suggest that a higher median survival could be achieved compared with conventional palliative surgery and systemic chemotherapy , therefore a r and omised phase III study is now being conducted Background Recently , the combination of complete cytoreductive surgery followed immediately by intraperitoneal chemotherapy achieved cure in some patients suffering from peritoneal carcinomatosis ( PC ) . It is now well established that the prognostic impact of the completeness of cytoreduction is high . However , two different modes of intraperitoneal chemotherapy are proposed : early postoperative intraperitoneal chemotherapy ( EPIC ) , which lasts for 5 days and is normothermic , and peroperative intraperitoneal chemohyperthermia ( IPCH ) . To date , the results of these procedures have never been compared . Aim of the study To compare the complications and therapeutic results of EPIC and IPCH after complete cytoreductive surgery of colorectal PC . Material s and methods Twenty-three consecutive patients with colorectal PC were selected based on the completeness of cytoreductive surgery and sufficient follow-up . They received IPCH with oxaliplatin ( 460 mg/m² ) in 2 l/m² of dextrose , for 30 min at an intraperitoneal temperature of 43 ° C , using the coliseum technique . We retrospectively carefully selected another 23 patients , for comparison purpose s , suffering from the same disease , with characteristics as similar as possible , but treated earlier with  EPIC ( mitomycin C 10 mg/m² at day 0 and 5-FU 650 mg/m² from days 1 to 4 ) , in 1 l/m² of ringer lactate . Data concerning these two groups were verified prospect ively , but this study was a comparative historical analysis . Results The two groups were statistically comparable , except for the duration of surgery which was 68 min longer for the IPCH group . Mortality and morbidity were not significantly different , even if two deaths occurred in the EPIC group , and none in the IPCH group . However , the rate of digestive fistulas was higher ( P = 0.02 ) in the EPIC group ( 26 % ) than in the IPCH group ( 0 % ) . Overall survival ( OS ) was higher in the IPCH group , ( 54 % at 5 years vs. 28 % for EPIC ) , but not significantly ( P = 0.22 ) . Peritoneal carcinomatosis recurred much ( P = 0.03 ) more frequently in the EPIC group ( 57 % ) than in the IPCH-group ( 26 % ) . Conclusion This study provides strong arguments indicating that IPCH with oxaliplatin is better tolerated than EPIC with mitomycin C and 5-FU , and is twice as efficient in curing residual peritoneal carcinomatosis measuring less than 1 mm Regional recurrence of malignant tumors in the peritoneal cavity usually signifies a poor prognosis for the host and often results in gastrointestinal complications requiring surgical intervention . One hundred patients with nongynecological malignancies found with peritoneal carcinomatosis were followed prospect ively . The most common primary tumors were colorectal ( N = 45 ) and pancreatic ( N = 20 ) carcinoma . When associated with pancreatic carcinoma , 65 % of patients had liver metastases and 60 % had ascites . The presence of ascites was associated with poor survival , with no patient surviving past 30 days . Ascites was also a sign of poor prognosis in patients with colorectal carcinoma . Among possible prognostic factors in colorectal carcinoma patients , only disease‐free interval , presence of lung metastases , and ascites showed statistically significant correlations with survival . Peritoneal carcinomatosis in sarcoma ( N = 7 ) and breast cancer ( N = 6 ) patients had median survival of 12 and 7 months , respectively . Surgical intervention for gastrointestinal complications in peritoneal carcinomatosis can provide significant palliation , with a few exceptions such as in patients with pancreatic or gastric carcinoma , ascites , and poor performance status BACKGROUND Peritonectomy combined with perioperative intraperitoneal chemotherapy is a successful treatment option for patients with peritoneal dissemination of appendiceal and colorectal malignancy . Despite its efficacy , recurrences remain a common problem . METHODS Patients with peritoneal dissemination from appendiceal or colorectal malignancy who underwent complete cytoreduction and perioperative intraperitoneal chemotherapy were included in this study . Data regarding recurrent disease found on abdominal exploration and /or diagnostic studies was extracted from a prospect i ve data base and analyzed . RESULTS Seventy patients with colorectal cancer carcinomatosis and 402 with appendiceal neoplasm were analyzed . Forty-nine of 70 and 111 of 402 patients developed documented recurrences . The median survival of 49 patients with colorectal cancer was 33 months while the median survival for patients with appendiceal neoplasms was not reached . The most common type of recurrent disease was a localized intra-abdominal recurrence for both appendiceal and colon cancer patients . Patients who underwent second surgery for recurrent disease had an improved survival . CONCLUSION Additional treatments should be strongly considered in patients who fail an initial cytoreduction combined with perioperative intraperitoneal chemotherapy . This result ed in 5-year survival in 17 % of colorectal patients and 70 % of the appendiceal mucinous neoplasm patients AIM The present study was specifically design ed to assess the major clinical and pathological variables of patients with colorectal peritoneal carcinomatosis in order to investigate whether currently used criteria appropriately select c and i date s for peritonectomy procedures ( cytoreductive surgery ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) . PATIENTS AND METHODS Preoperative , operative and follow-up data on 146 consecutive patients presenting with peritoneal carcinomatosis of colorectal origin and treated by surgical cytoreduction combined with HIPEC in 5 Italian Hospital and University Centers were prospect ively entered in a common data base . Univariate and multivariate analyses were used to assess the prognostic value of clinical and pathologic factors . RESULTS Over a minimum 24-month follow-up , the overall morbidity rate was 27.4 % ( mortality rate : 2.7 % ) and was directly related to the extent of surgery . Peritoneal cancer index ( PCI ) , unfavorable peritoneal sites , synchronous or previously resected liver metastasis and the completeness of cytoreduction , all emerged as independent prognostic factors correlated with survival . CONCLUSIONS Until research provides more effective criteria for selecting patients based upon the biomolecular features of carcinomatosis , patients should be selected according to the existing independent prognostic variables PURPOSE Symptoms and complications of metastatic colorectal cancer ( mCRC ) differ by metastatic sites . There is a paucity of prospect i ve survival data for patients with peritoneal carcinomatosis colorectal cancer ( pcCRC ) . We characterized outcomes of patients with pcCRC enrolled onto two prospect i ve r and omized trials of  chemotherapy and contrasted that with other manifestations of mCRC ( non-pcCRC ) . METHODS A total of 2,095 patients enrolled onto two prospect i ve r and omized trials were evaluated for  overall survival ( OS ) and progression-free survival ( PFS ) . A Cox proportional hazard model was used to assess the adjusted associations . RESULTS The characteristics of the pcCRC group ( n = 364 ) were similar to those of the non-pcCRC patients in median age ( 63 v 61 years , P = .23 ) , sex ( 57 % males v 61 % , P = .23 ) , and performance status ( Eastern Cooperative Oncology Group performance status 0 or 1 94 % v 96 % , P = .06 ) , but differed in frequency of liver ( 63 % v 82 % , P < .001 ) and lung metastases ( 27 % v 34 % , P = .01 ) . Median OS ( 12.7 v 17.6 months , hazard ratio [ HR ] = 1.3 ; 95 % CI , 1.2 to 1.5 ; P < .001 ) and PFS ( 5.8 v 7.2 months , HR = 1.2 ; 95 % CI , 1.1 to 1.3 ; P = .001 ) were shorter for pcCRC versus non-pcCRC . The unfavorable prognostic influence of pcCRC remained after adjusting for age , PS , liver metastases , and other factors ( OS : HR = 1.3 , P < .001 ; PFS : HR = 1.1 , P = .02 ) . Infusional fluorouracil , leucovorin , and oxaliplatin was superior to irinotecan , leucovorin , and fluorouracil as a first-line treatment among pcCRC ( HR for OS = 0.62 , P = .005 ) and non-pcCRC patients ( HR = 0.66 , P < .001 ) . CONCLUSION pcCRC is associated with a significantly shorter OS and PFS as compared with other manifestations of mCRC . Future trials for mCRC should consider stratifying on the basis of pcCRC status BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy is becoming an accepted treatment of carcinomatosis . METHODS Between February 2000 and January 2008 , there were 101 consecutive patients with carcinomatosis who were treated with cytoreductive surgery + hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy . Patient and tumor characteristics , surgical details , complications , disease-free survival ( DFS ) , and overall survival ( OS ) were recorded prospect ively . RESULTS The majority ( 82 % ) of patients , median age 49 years ( range , 18 - 77 y ) , had complete macroscopic cytoreduction ( completeness of cytoreduction score , 0 ) despite a generally extensive tumor burden . Perioperative mortality and grade III/IV morbidity rates were 4 % and 39 % , respectively . Preliminary median DFS and OS have not been defined for appendix tumors at a median follow-up period of 16 months ( range , 1 - 86 mo ) . Median DFS and OS for colonic tumors are 8 months and 26 months , respectively , with a median follow-up period of 12 months ( range , 1 - 48 mo ) . CONCLUSIONS Combined regional treatment is feasible and holds significant promise for the treatment of peritoneal carcinomatosis Abstract Background Peritoneal carcinomatosis of colorectal cancer is probably best treated by cytoreduction and hyperthermic intraperitoneal chemotherapy ( HIPEC ) . In The Netherl and s Cancer Institute , this treatment has been performed since 1995 . The long tradition of this treatment enabled us to study long-term survival in detail . Methods Between 1995 and 2003 , 117 patients were treated by cytoreduction and HIPEC .  The aim of the cytoreduction was to remove all visible tumor . After the cytoreduction , the abdomen was perfused with mitomycin C ( 35 mg/m2 ) at 40 ° C to 41 ° C for 90 minutes  . Survival was calculated by the Kaplan-Meier method . Survival was also analyzed for the following subgroups : no residual tumor , residual tumor ≤2.5 mm , and more residual tumor . Hazard ratios for each of the seven abdominal regions were calculated to determine the influence on survival . Results The median survival was 21.8 months . The 1- , 3- , and 5-year survival rates were 75 % , 28 % , and 19 % , respectively . The Kaplan-Meier curve reached a plateau of 18 % at 54 months . In 59 patients a complete cytoreduction was achieved , and in 41 patients there was minimal residual disease . The median survival of these patient groups was 42.9 and 17.4 months , respectively . When gross macroscopic tumor was left behind , as was the case in 17 patients , the median survival was 5 months . Involvement of the small bowel before cytoreduction was associated with poorer outcome . Conclusions Cytoreduction followed by HIPEC showed a median survival of 21 months . From 3 years on , a consistent group of 18 % of patients stayed alive INTRODUCTION Peritoneal metastases ( PM ) can be treated with cytoreduction surgery ( CRS ) with intraoperative heated intraperitoneal chemotherapy ( HIPEC ) plus or minus early postoperative intraperitoneal chemotherapy ( EPIC ) . HIPEC + EPIC may be associated with more complications than HIPEC alone . METHODS A prospect i ve data base of consecutive patients undergoing CRS + HIPEC ± EPIC at the University of Calgary between February 2000 and May 2011 was review ed . Patient , tumor , and perioperative variables included peritoneal cancer index ( PCI ) , completeness of cytoreduction ( CCR ) score , HIPEC ± EPIC type , and grade III/IV complications . RESULTS 198 patients had a CCR score of 0/1 and received : ( 1 ) HIPEC mitomycin C + EPIC 5-fluorouracil for 5 days ( n = 85 ; February 2000-January 2008 ) ; or ( 2 ) HIPEC oxaliplatin with IV 5-fluorouracil + no EPIC ( n = 113 ; February 2008-May 2011 ) . Clinicodemographics were similar except PCI was higher in the HIPEC-alone group ( mean PCI 22 vs. 17 ; P = 0.02 ) . The rate of grade III/IV complications was higher in the HIPEC + EPIC group ( 44.7 % vs. 31.0 % ; P = 0.05 ) . On multivariate logistic regression only HIPEC + EPIC and PCI > 26 were associated with an increased rate of complications . CONCLUSION In patients with PM , the use of EPIC , in combination with CRS and HIPEC , is associated with an increased rate of complications . Surgeons should consider using HIPEC only ( without EPIC ) Background Up to 25 % of patients with metastatic colorectal cancer ( CRC ) present with peritoneal carcinomatosis ( PC ) as the only site of metastases . Complete cytoreductive surgery ( CCRS ) followed by hyperthermic intraperitoneal chemotherapy ( HIPEC ) aims for locoregional disease control and long-term survival . Oxaliplatin is effective for treating advanced CRC . This study assesses the safety and efficacy of CCRS with HIPEC with oxaliplatin for patients with PC of CRC . Methods A Belgian prospect i ve multicenter registry was performed to monitor perioperative morbidity and assess mortality , disease-free survival ( DFS ) , and overall survival ( OS ) . Results Forty-eight consecutive patients underwent CCRS ( R0/1 ) with HIPEC ( male/female ratio 17/31 , median age 60 years , range 24–76 years ) .  Median PC index was 11 ( range 1–22 ) . Median operation time was 460 ( range 125–840 ) min , with a median blood loss of 475 ( range 2–6,000 ) ml . Thirty-day mortality was 0 % . Complication rate ( any grade ) was 52.1 % . Anastomotic leakage occurred in 10.4 % of patients , bleeding in 6.3 % , and bowel perforation in 2.1 % . Median hospital stay was 20 ( range 5–65 ) days . At median follow-up of 22.7 ( range 3.2–55.7 ) months , OS was 97.9 % [ 95 % confidence interval ( CI ) 86.1–99.7 ] at 1 year and 88.7 % ( 95 % CI 73.6–95.4 ) at 2 years . DFS at 1 year was 65.8 % ( 95 % CI 52.3–76.2 ) and 45.5 % ( 95 % CI 34.3–55.9 ) at 2 years . Median time until recurrence was 19.8 months ( 95 % CI 12–upper limit not defined ) . Only after dichotomizing PC index was a significant difference in OS found between low and high PC index . Conclusions CCRS followed by HIPEC with oxaliplatin for PC from CRC can be implemented with acceptable morbidity . Long-term DFS and OS can be achieved in selected patients BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy ( HIPEC ) are gaining acceptance as treatment for selected patients with colorectal cancer with peritoneal carcinomatosis ( CRCPC ) . Tremendous variations exist in the HIPEC delivery . METHODS The American Society of Peritoneal Surface Malignancies ( ASPSM ) examined the overall survival in patients with CRCPC who underwent a complete cytoreduction and HIPEC with Oxaliplatin vs. Mitomycin C ( MMC )  , stratifying them by the Peritoneal Surface Disease Severity Score ( PSDSS ) . RESULTS Median overall survival ( OS ) of 539 patients with complete cytoreduction was 32.6 months , 32.7 months for the MMC group and 31.4 months for the Oxaliplatin group ( P = 0.925 ) . However , when stratified by PSDSS , median OS rates in PSDSS I/II patients were 54.3 months in those receiving MMC vs. 28.2 months in those receiving oxaliplatin ( P = 0.012 ) , whereas in PSDSS III/IV patients , median OS rates were 19.4 months in those receiving MMC vs. 30.4 months in those receiving Oxaliplatin ( P = 0.427 ) . CONCLUSION These data suggest that MMC might be a better agent for HIPEC delivery than Oxaliplatin in patients with CRCPC , favorable histologies and low burden of disease ( PSDSS I/II ) undergoing complete cytoreduction . Prospect i ve studies are warranted , which stratify patients by their PSDSS and r and omize them to HIPEC with MMC vs. Oxaliplatin BACKGROUND Peritoneal dissemination of abdominal malignancy ( carcinomatosis ) has a clinical course marked by bowel obstruction and death ; it traditionally does not respond well to systemic therapy and has been approached with nihilism . To treat carcinomatosis , we use cytoreductive surgery ( CS ) with hyperthermic intraperitoneal chemotherapy ( HIPEC ) . METHODS A prospect i ve data base of patients has been maintained since 1992 . Patients with biopsy-proven peritoneal surface disease were uniformly evaluated for , and treated with , CS and HIPEC . Patient demographics , performance status ( Eastern Cooperative Oncology Group ) , resection status , and peritoneal surface disease were classified according to primary site . Univariate and multivariate analyses were performed . The experience was divided into quintiles and outcomes compared . RESULTS Between 1991 and 2013 , a total of 1,000 patients underwent 1,097 HIPEC procedures . Mean age was 52.9 years and 53.1 % were female . Primary tumor site was appendix in 472 ( 47.2 % ) , colorectal in 248 ( 24.8 % ) , mesothelioma in 72 ( 7.2 % ) , ovary in 69 ( 6.9 % ) , gastric in 46 ( 4.6 % ) , and other in 97 ( 9.7 % ) . Thirty-day mortality rate was 3.8 % and median hospital stay was 8 days . Median overall survival was 29.4 months , with a 5-year survival rate of 32.5 % . Factors correlating with improved survival on univariate and multivariate analysis ( p ≤ 0.0001 for each ) were preoperative performance status , primary tumor type , resection status , and experience quintile ( p = 0.04 ) . For the 5 quintiles , the 1- and 5-year survival rates , as well as the complete cytoreduction score ( R0 , R1 , R2a ) have increased , and transfusions , stoma creations , and complications have all decreased significantly ( p < .001 for all ) . CONCLUSIONS This largest reported single-center experience with CS and HIPEC demonstrates that prognostic factors include primary site , performance status , completeness of resection , and institutional experience . The data show that outcomes have improved over time , with more complete cytoreduction and fewer serious complications , transfusions , and stomas . This was due to better patient selection and increased operative experience . Cytoreductive surgery with HIPEC represents a substantial improvement in outcomes compared with historical series , and shows that meaningful long-term survival is possible for selected carcinomatosis patients . Multi-institutional cooperative trials are needed to refine the use of CS and HIPEC PURPOSE To confirm the findings from uncontrolled studies that aggressive cytoreduction in combination with hyperthermic intraperitoneal chemotherapy ( HIPEC ) is superior to st and ard treatment in patients with peritoneal carcinomatosis of colorectal cancer origin . PATIENTS AND METHODS Between February 1998 and August 2001 , 105 patients were r and omly assigned to receive either st and ard treatment consisting of systemic chemotherapy ( fluorouracil-leucovorin ) with or without palliative surgery , or experimental therapy consisting of aggressive cytoreduction with HIPEC , followed by the same systemic chemotherapy regime . The primary end point was survival . RESULTS After a median follow-up period of 21.6 months , the median survival was 12.6 months in the st and ard therapy arm and 22.3 months in the experimental therapy arm ( log-rank test , P = .032 ) . The treatment-related mortality in the aggressive therapy group was 8 % . Most complications from HIPEC were related to bowel leakage . Subgroup analysis of the HIPEC group showed that patients with 0 to 5 of the 7 regions of the abdominal cavity involved by tumor at the time of the cytoreduction had a significantly better survival than patients with 6 or 7 affected regions ( log-rank test , P < .0001 ) . If the cytoreduction was macroscopically complete ( R-1 ) , the median survival was also significantly better than in patients with limited ( R-2a ) , or extensive residual disease ( R-2b ; log-rank test , P < .0001 ) . CONCLUSION Cytoreduction followed by HIPEC improves survival in patients with peritoneal carcinomatosis of colorectal origin . However , patients with involvement of six or more regions of the abdominal cavity , or grossly incomplete cytoreduction , had still a grave prognosis AIMS Selecting patients for cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy ( HIPEC )  remains challenging . We compared the predictive power of three intra-operative assessment tools of peritoneal involvement of colorectal cancer . METHODS Ninety-two procedures ( 1999 - 2005 ) were prospect ively scored using the Simplified Peritoneal Cancer Index ( SPCI ) and 7 Region Count . The Peritoneal Cancer Index ( PCI ) was retrospectively scored using the SPCI tool , operative notes and pathological reports . Endpoints were completeness of cytoreduction and overall survival . Logistic regression and Receiver Operating Characteristic ( ROC ) curves were applied to compare the predictive value of the three scoring systems on completeness of cytoreduction . RESULTS After a median follow-up of 31 months , the median overall survival was 25.6 months . It decreased to 7.3 months , when cytoreduction was incomplete ( p=0.001 ) . An increased PCI , SPCI or number of regions were all associated with a decrease in probability of complete cytoreduction ( p<0.05 ) . With complete cytoreduction as outcome , the ROC areas for the PCI , SPCI and 7 Region Count were 0.92 , 0.94 and 0.90 , respectively ( p=0.14 ) . Using a cut-off value of 16 in the PCI system ( p=0.03 ) , 13 in the SPCI system ( p=0.04 ) and 6 regions in the 7 Region Count ( p=0.0002 ) the probability of complete cytoreduction decreased significantly . CONCLUSION The PCI , SPCI and 7 Region Count are useful and equally effective prognostic tools predicting completeness of cytoreduction and associated improved survival . The 7 Region Count may be preferred due to its practical simplicity Survival benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion was demonstrated by a prospect i ve r and omized trial for colorectal peritoneal carcinomatosis . Because of a recent substantial improvement in chemotherapy , the authors analyzed treatment options of colorectal carcinomatosis in the current era Background : Cytoreductive surgery ( CS ) and intraperitoneal hyperthermic chemotherapy ( IPHC ) are efficacious in patients with disseminated mucinous tumors of the appendix . We review ed our experience using this approach for nonappendiceal colorectal cancer ( NACC ) . Methods : We performed a retrospective chart review of a prospect i ve data base for patients undergoing CS and IPHC with mitomycin C for peritoneal carcinomatosis from colorectal primary lesions between December 1991 and April 2002 . Results : There were 77 patients , with a median age of 54 years . Peritoneal carcinomatosis was synchronous and metachronous in 27 % and 73 % patients , respectively . Seventy-five percent of patients ( n = 58 ) had received chemotherapy prior to IPHC .  Complete resection of all gross disease was accomplished in 37 patients ( 48 % ) . The mean carcinoembryonic antigen level decreased from a preoperative value of 31.2 to a postoperative value of 6.9 ( P < .0001 ) . Overall survival ( OS ) at 1 , 3 , and 5 years was 56 % , 25 % , and 17 % , respectively . With a median follow-up of 15 months , the median OS was 16 months . Perioperative morbidity and mortality were 30 % and 12 % , respectively . Hematologic toxicity occurred in 15 patients ( 19 % ) . Cox regression analysis identified poor performance status ( P = .018 ) , bowel obstruction ( P = .001 ) , malignant ascites ( P = .001 ) , and incomplete resection of gross disease ( P = .011 ) as independent predictors of decreased survival . Patients with complete resection of all gross disease had a 5-year OS of 34 % , with a median OS of 28 months . Conclusions : CS and IPHC with mitomycin C can improve outcomes for select patients with peritoneal spread from NACC . One third of patients who undergo complete resection of gross disease have long-term survival Background Cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) have been shown to improve survival in selected patients with peritoneal carcinomatosis . We review our institutional experience with the procedure and evaluate the overall survival ( OS ) and disease-free survival ( DFS ) rates in 100 consecutive patients . Methods Data were prospect ively collected from 100 consecutive patients with peritoneal carcinomatosis treated by CRS and HIPEC at the National Cancer Centre Singapore between April 2001 and May 2012 . Our primary end points were OS and DFS . Results Of the 100 patients , 84 were of Chinese ethnicity , 3 were Malay , 6 were Indian , and 7 were of other ethnicities . Primary tumors were ovarian cancer ( n = 39 ) , colorectal cancer ( n = 28 ) , primary peritoneal ( n = 6 ) , appendiceal cancer ( n = 20 ) , and mesothelioma ( n = 7 ) . Median follow-up duration was 21 months . At 5 years , the DFS was 26.3 % and OS was 50.9 % . Factors influencing OS and DFS were cytoreductive score , primary cancer , and disease-free interval of more than 12 months on univariate analysis . The only factors that remained significant for prognosis after multivariate analysis were primary cancer and cytoreductive score . Thirty-day morbidity was 56 % , and there were no 30-day mortalities . Conclusions CRS and HIPEC can be safely carried out in Asian patients with peritoneal carcinomatosis from ovarian , colorectal , appendiceal , mesothelioma , and primary peritoneal origins . Overall , the ovarian , appendiceal , mesothelioma , and primary peritoneal cancer patients tended to do better than the colorectal patients , but careful patient selection ensuring that optimal cytoreduction can be achieved is essential for the success of this procedure INTRODUCTION Compared with intravenous chemotherapy , cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) have been shown to improve survival in patients with recurrent colorectal disease confined to the peritoneum . We report our experience with CRS and HIPEC for colorectal cancer patients with peritoneal carcinomatosis , evaluating prognostic factors for disease-free survival ( DFS ) , overall survival ( OS ) , and perioperative morbidity and mortality . METHODS All patients who underwent CRS and HIPEC were included in our study . Clinical characteristics , operative data , and 30-day morbidity and mortality were collected and evaluated . RESULTS Between January 2001 and December 2012 , there were 35 consecutive patients who underwent CRS and HIPEC at our institution . Thirty-three patients ( 94 % ) had optimal cytoreduction . No 30-day mortality was reported , but 14 patients had postoperative complications . The median DFS was 9.4 months ( 95 % confidence interval 5.5 - 18.7 months ) , and DFS at 1 year , 3 years , and 5 years were 43.8 % , 22.3 % , and 22.3 % , respectively . The median OS was calculated to be 27.1 months ( 95 % confidence interval 15.3 - 39.1 ) , and the OS at 1 year , 3 years , and 5 years were 83.7 % , 38.2 % , and 19.1 % , respectively . CONCLUSION CRS and HIPEC can provide survival benefit , with reasonable morbidity and mortality for Asian patients with peritoneal carcinomatosis from colorectal cancer . Patient selection and perioperative management of the patients are key to the success of the procedure AIMS Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has been reported as a treatment option for patients with peritoneal carcinomatosis from colorectal carcinoma . METHODS Thirty patients with colorectal peritoneal carcinomatosis underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy .  All appendiceal cancers were excluded . All patients were followed until January 2006 or death . Univariate analysis was performed to evaluate significant prognostic factors for overall survival , defined from the time of surgery . RESULTS There were 13 male patients . The mean age at the time of surgery was 54years . There was no hospital mortality . The mean duration of hospital stay was 27days . The overall median survival was 29months , with 1- and 2-year survival of 72 % and 64 % , respectively . Twenty-one patients had complete cytoreduction and their 1- and 2-year survival rates were 85 % and 71 % , respectively . Univariate analysis demonstrated that patients with non-mucinous colorectal adenocarcinoma , Peritoneal Cancer Index ( PCI ) < or = 13 , and complete cytoreduction were associated with an improved survival . CONCLUSIONS This study reported on 30 patients who underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy  for colorectal peritoneal carcinomatosis . Patients with mucinous tumour had relatively more extensive intraperitoneal disease . Non-mucinous colorectal adenocarcinoma , PCI < or = 13 , and complete cytoreduction were associated with an improved survival PURPOSE In a previous study of treatment for advanced colorectal cancer , the LV5FU2 regimen , comprising leucovorin ( LV ) plus bolus and infusional fluorouracil ( 5FU ) every 2 weeks , was superior to the st and ard North Central Cancer Treatment Group/Mayo Clinic 5-day bolus 5FU/LV regimen . This phase III study investigated the effect of combining oxaliplatin with LV5FU2 , with progression-free survival as the primary end point . PATIENTS AND METHODS Four hundred twenty previously untreated patients with measurable disease were r and omized to receive a 2-hour infusion of LV ( 200 mg/m(2)/d ) followed by a 5FU bolus ( 400 mg/m(2)/d ) and 22-hour infusion ( 600 mg/m(2)/d ) for 2 consecutive days every 2 weeks , either alone or together with oxaliplatin 85 mg/m(2 ) as a 2-hour infusion on day 1 . RESULTS Patients allocated to oxaliplatin plus LV5FU2 had significantly longer progression-free survival ( median , 9.0 v 6.2 months ; P = .0003 ) and better response rate ( 50.7 % v 22.3 % ; P = .0001 ) when compared with the control arm . The improvement in overall survival did not reach significance ( median , 16.2 v 14.7 months ; P = . 12 ) . LV5FU2 plus oxaliplatin gave higher frequencies of National Cancer Institute common toxicity criteria grade 3/4 neutropenia ( 41 . 7 % v 5.3 % of patients ) , grade 3/4 diarrhea ( 11.9 % v 5.3 % ) , and grade 3 neurosensory toxicity ( 18.2 % v 0 % ) , but this did not result in impairment of quality of life ( QoL ) . Survival without disease progression or deterioration in global health status was longer in patients allocated to oxaliplatin treatment ( P = .004 ) . CONCLUSION The LV5FU2-oxaliplatin combination seems beneficial as first-line therapy in advanced colorectal cancer , demonstrating a prolonged progression-free survival with acceptable tolerability and maintenance of Peritoneal carcinomatosis ( PC ) is fatal , despite st and ard systemic chemotherapy . A new approach that combines maximal surgery with maximal regional chemotherapy has potential to cure selected patients who have colorectal PC . The authors have reported the oncologic results of this combined treatment Background : Cytoreductive surgery ( CRS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) has been demonstrated to have an improved survival over systemic chemotherapy for patients with colorectal peritoneal carcinomatosis ( CRPC ) in a r and omized controlled trial . Despite the increasing clinical evidence , controversies still exist regarding the st and ard treatment for these patients . Methods : Between January 1997 and October 2007 , 50 patients with isolated CRPC underwent CRS and HIPEC at the St. George Hospital , Sydney . All patients underwent preoperative chest , abdominal and pelvic computed tomography scans , and positron emission tomography .  All clinicopathologic and treatment-related data were obtained prospect ively and computed in univariate and multivariate analyses to determine their prognostic significance for overall survival . Results : The mean age at the time of CRS was 55 ( SD = 14 ) years . There were 19 ( 38 % ) male patients . The overall median survival was 29 months ( range 1–102 ) with a 3-year survival rate of 39 % . Three clinicopathologic factors were found to be significant for overall survival : tumor differentiation ( P < 0.001 ) , peritoneal cancer index ( P = 0.021 ) , and completeness of cytoreduction ( P < 0.001 ) . In the multivariate analysis of overall survival , 2 factors were identified to be independently associated with an improved survival : well-differentiated tumor ( P = 0.045 ) and complete cytoreduction ( P = 0.023 ) . Conclusions : CRPC patients with low tumor volume , well/moderately differentiated tumors and complete cytoreduction may potentially benefit from the combined treatment . The combined treatment for patients with isolated colorectal peritoneal carcinomatosis should be considered to be the current st and ard of care BACKGROUND Peritoneal carcinomatosis imposes an enormous clinical burden to the oncologic community . This study reports the patterns of care of the locoregional approach of cytoreductive surgery ( CRS ) and perioperative intraperitoneal chemotherapy as a curative procedure for peritoneal carcinomatosis from the experience of a single tertiary center in Australia . METHODS We performed a review of clinical records from a prospect i ve data base of patients who were treated at the St George Hospital Peritoneal Surface Malignancy Program according to a st and ard protocol . RESULTS A total of 308 CRS were performed in 249 patients with peritoneal surface malignancy ; the mean age was 53 years and 55 % were women . Over the years , we exp and ed the age limit for treatment ( P = .03 ) , reduced intensive care unit stays ( P = .04 ) , reduced amount of blood transfusion ( P = .03 ) , treated patients with a higher peritoneal cancer index ( P < .001 ) , achieved higher rates of complete cytoreduction ( P = .003 ) , increased use of PIC ( P < .001 ) , and improved complication rate ( P = .02 ) and mortality rate ( P = .01 ) . The median survival of patients treated over the years also improved ( P = .001 ) . CONCLUSIONS We show the maturity of the treatment of peritoneal carcinomatosis with CRS and perioperative intraperitoneal chemotherapy in our institution after an initial learning curve with expansion of the selection criteria , improved perioperative outcomes , improved surgical results , and long-term survival outcomes BACKGROUND The objective of this study was to report a long-term survival analysis of a phase II protocol of cytoreductive surgery ( CS ) and heated intraperitoneal chemotherapy ( HIPEC ) in the treatment of peritoneal carcinomatosis ( PCs ) . METHODS Between 2000 and 2008 , 101 consecutive patients were treated with  CS , HIPEC and early postoperative intraperitoneal chemotherapy using a st and ardized protocol . Disease recurrence and mortality data were collected prospect ively . Primary outcomes were median , 3-year , and 5-year disease-free survival ( DFS ) and overall survival ( OS ) . RESULTS The median age was 49 years ( range , 18 - 77 years ) , and the majority ( 82 % ) had complete CS with no gross residual cancer . Tumor types included appendiceal ( n = 58 ) , colorectal ( n = 31 ) , and other ( n = 12 ) .  Median follow-up was 28 months ( range , 0 - 119 months ) , with minimum of 24 months among survivors . For appendiceal tumors , median DFS was 34 months ( range , 0 - 119 months ) and OS has not yet been defined . Three-year and 5-year DFS was 48 % and 42 % , respectively , and 3-year and 5-year OS was 76 % and 62 % , respectively . For colorectal carcinomatosis , median disease-free and OS was 9 months ( range , 0 - 87 months ) and 27 months ( range , 0 - 87 months ) , respectively . Three-year and 5-year DFS was 34 % and 26 % , respectively , and 3-year and 5-year OS was 38 % and 34 % , respectively . CONCLUSIONS Long-term survival with regional treatment of PC from appendiceal or colorectal primary tumors with CS and HIPEC is achievable BACKGROUND AND OBJECTIVES Failure to respond to systemic chemotherapy is considered an exclusion criterion by some institutions for treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy ( HIPEC ) . However , it is unknown if these patients benefit from HIPEC treatment . This study aim ed to report on outcomes of HIPEC in patients who failed to respond to adjuvant systemic chemotherapy .  METHODS Patients were selected from a prospect i ve data base containing data on all patients who underwent HIPEC , using the following criteria : ( 1 ) Metachronous peritoneal carcinomatosis ( PC ) from colorectal origin , ( 2 ) adjuvant chemotherapy after primary tumor resection , ( 3 ) development of PC or local recurrence within 18 months after start of chemotherapy .  Treatment and survival data were retrospectively collected . RESULTS Twenty-one patients ( 29 % male , mean age 57 years ) were included .  Median time to recurrence of disease was 9 months ( range 2 - 15 ) after first chemotherapy administration . Median survival was 28 months ( range 3 - 100 ) . One- and 2-year survival were 71 % and 43 % , respectively . CONCLUSIONS Patients who initially failed to respond to systemic adjuvant treatment showed a survival after HIPEC similar to results reported in literature in patients with unknown responsiveness . Failure to respond to previous adjuvant systemic treatment should therefore not be considered an exclusion criterion for HIPEC treatment PURPOSE To compare the long-term survival of patients with isolated and resectable peritoneal carcinomatosis ( PC ) in comparable groups of patients treated with systemic chemotherapy containing oxaliplatin or irinotecan or by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) . PATIENTS AND METHODS All patients with gross PC from colorectal adenocarcinoma who had undergone cytoreductive surgery plus HIPEC from 1998 to 2003 were evaluated . The st and ard group was constituted by selecting patients with colorectal PC treated with palliative chemotherapy during the same period , but who had not benefited from HIPEC because the technique was unavailable in the center at that time . RESULTS Forty-eight patients were retrospectively included in the st and ard group and were compared with 48 patients who had undergone HIPEC  and were evaluated prospect ively . All characteristics were comparable except age and tumor differentiation . There was no difference in systemic chemotherapy , with a mean of 2.3 lines per patient . Median follow-up was 95.7 months in the st and ard group versus 63 months in the HIPEC group . Two-year and 5-year overall survival rates were 81 % and 51 % for the HIPEC group , respectively , and 65 % and 13 % for the st and ard group , respectively . Median survival was 23.9 months in the st and ard group versus 62.7 months in the HIPEC group ( P < .05 , log-rank test ) . CONCLUSION Patients with isolated , resectable PC achieve a median survival of 24 months with modern chemotherapies , but only surgical cytoreduction plus HIPEC is able to prolong median survival to roughly 63 months , with a 5-year survival rate of 51 %
Objectives The therapeutic efficacy of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) for patients with peritoneal carcinomatosis ( PC ) from colorectal cancer ( CRC ) is still under debate .
This meta- analysis and systematic review of published literature on this comprehensive strategy aims to evaluate its efficacy on CRC patients with PC .