Failure Analysis of Recurrent Disease Following Complete Cytoreduction and Perioperative Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Colorectal Cancer Cytoreductive Surgery with Selective Versus Complete Parietal Peritonectomy Followed by Hyperthermic Intraperitoneal Chemotherapy in Patients with Diffuse Malignant Peritoneal Mesothelioma: A Controlled Study Outcomes of colorectal cancer patients with peritoneal carcinomatosis treated with chemotherapy with and without targeted therapy. Neoadjuvant Chemotherapy with Bevacizumab May Improve Outcome after Cytoreduction and Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) for Colorectal Carcinomatosis Risk factors for recurrence following complete cytoreductive surgery and HIPEC in colorectal cancer-derived peritoneal surface malignancies Morbidity and Mortality Outcomes of Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy at a Single Tertiary Institution: Towards a New Perspective of This Treatment Peritoneal carcinomatosis of colorectal origin. Cytoreductive Surgery Under Aminolevulinic Acid-Mediated Photodynamic Diagnosis Plus Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Ovarian Cancer and Primary Peritoneal Carcinoma: Results of a Phase I Trial Cytoreduction and heated intraperitoneal chemotherapy for colorectal cancer: are we excluding patients who may benefit? Cytoreduction and HIPEC in The Netherlands: Nationwide Long-term Outcome Following the Dutch Protocol Impact of Aggressive Histology and Location of Primary Tumor on the Efficacy of Surgical Therapy for Peritoneal Carcinomatosis of Colorectal Origin Perioperative systemic chemotherapy in peritoneal carcinomatosis of lymph node positive colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Recurrences after Peritoneal Carcinomatosis of Colorectal Origin Treated by Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy: Location, Treatment, and Outcome Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. Prognostic factors and oncologic outcome in 146 patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: Italian multicenter study S.I.T.I.L.O. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of north central cancer treatment group phase III trials N9741 and N9841. Secondary cytoreductive surgery and peri-operative intraperitoneal chemotherapy for peritoneal recurrence of colorectal and appendiceal peritoneal carcinomatosis following prior primary cytoreduction. The Treatment of Peritoneal Carcinomatosis of Colorectal Cancer with Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Peroperative Chemotherapy (HIPEC) with Oxaliplatin: A Belgian Multicentre Prospective Phase II Clinical Study Assessment of relapse in patients with peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy using F-18-FDG-PET/CT. The Impact of Postoperative Complications on Long-Term Outcomes Following Curative Resection for Colorectal Cancer Is There a Possibility of a Cure in Patients With Colorectal Peritoneal Carcinomatosis Amenable to Complete Cytoreductive Surgery and Intraperitoneal Chemotherapy? Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Asian Patients: 100 Consecutive Patients in a Single Institution
Background The aim of this study was to analyze the anatomic distribution , timing , and outcomes of recurrent disease after complete cytoreduction and perioperative intraperitoneal chemotherapy ( PIC ) for peritoneal carcinomatosis of colorectal origin . Methods Data regarding all patients who underwent complete cytoreduction and PIC for carcinomatosis from colorectal cancer were extracted from a prospect ively collected data base . The information regarding recurrent disease found on diagnostic evaluation and /or abdominal exploration was analyzed . Results Seventy patients underwent complete cytoreduction and perioperative intraperitoneal chemotherapy  , and 49 of them had documented recurrent disease . The median time to progression for these 49 patients was 9 months while their median survival was 30 months . Eighteen patients had a localized intra-abdominal recurrence , 10 had diffuse intraperitoneal recurrence , 10 had isolated distant metastases , and 11 had a combination of distant metastases and intra-abdominal recurrence . There was a statistically significant difference in survival for patients with different patterns of recurrence ( P = .012 ) . Twenty-six patients underwent a second operation . The median survival of these patients was significantly longer than that of patients who did not have a second operation ( 39 vs 20 months , P = .0003 ) . Four of the 49 patients with recurrences were still alive at the time of last follow-up , and three of them have no evidence of disease 73 , 96 , and 206 months after the diagnosis of recurrence . Conclusions Recurrence is a frequent event after optimal cytoreduction and PIC for carcinomatosis from colorectal cancer . Surgical treatment for a selected group of patients with recurrent disease may result in long-term survival Background Combined treatment involving peritonectomy procedures , multivisceral resections , and hyperthermic intraperitoneal chemotherapy ( HIPEC ) has reportedly result ed in survival benefit for peritoneal surface malignancies , including diffuse malignant peritoneal mesothelioma ( DMPM ) . Many unanswered questions remain regarding the surgical options in the management of DMPM . The aim of this case – control study was to assess the impact of the type and extent of parietal peritonectomy on survival and operative outcomes . Methods Thirty patients with DMPM undergoing selective parietal peritonectomy ( SPP ) of macroscopically involved regions , and 30 matched patients undergoing routine complete parietal peritonectomy ( CPP ) , regardless of disease distribution , were retrospectively identified from a prospect i ve data base . Results Groups were comparable for all characteristics , except for a higher proportion of patients treated before July 2003 and undergoing preoperative systemic chemotherapy in the SPP group . Median follow-up was 86.2 months in the SPP group and 50.3 months in the CPP group . Median overall survival was 29.6 months in the SPP group and not reached in the CPP group ; 5-year overall survival was 40.0 % and 63.9 % , respectively ( P = 0.0269 ) . At multivariate analysis , CPP versus SPP was recognized as an independent predictor of better prognosis , along with complete cytoreduction , negative lymph nodes , epithelial histology , and lower MIB-1 labelling index . Morbidity and reoperation rates were not different between groups . No operative mortality occurred . In 12 of 24 patients undergoing CPP , pathologic examination detected disease involvement on parietal surfaces with no evident tumor at surgical exploration . Conclusions CPP improved survival in patients with DMPM undergoing combined treatment . This information may contribute to st and ardize surgical options for DMPM and other peritoneal malignancies BACKGROUND Although systemic therapies have shown to result in survival benefit in patients with metastatic colorectal cancer ( mCRC ) , outcomes in patients with peritoneal carcinomatosis ( PC ) are poor . No data are available on outcomes of current chemotherapy schedules plus targeted agents in mCRC patients with PC . METHODS Previously untreated mCRC patients treated with chemotherapy in the CAIRO study and with chemotherapy and targeted therapy in the CAIRO2 study were included and retrospectively analysed according to presence or absence of PC at r and omisation . Patient demographics , primary tumour characteristics , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of toxicity were evaluated . RESULTS Thirty-four patients with PC were identified in the CAIRO study and 47 patients in the CAIRO2 study .  Median OS was decreased for patients with PC compared with patients without PC ( CAIRO : 10.4 versus 17.3 months , respectively ( p ≤ 0.001 ) ; CAIRO2 : 15.2 versus 20.7 months , respectively ( p < 0.001 ) ) . Median number of treatment cycles did not differ between patients with or without PC in both studies . Occurrence of major toxicity was more frequent in patients with PC treated with sequential chemotherapy in the CAIRO study as compared to patients without PC . This was not reflected in reasons to discontinue treatment . In the CAIRO2 study , no differences in major toxicity were observed . CONCLUSION Our data demonstrate decreased efficacy of current st and ard chemotherapy with and without targeted agents in mCRC patients with PC . This suggests that the poor outcome can not be explained by undertreatment or increased susceptibility to toxicity , but rather by relative resistance to treatment 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 Purpose Recurrent disease following complete cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) is a relevant clinical scenario . We aim ed to determine risk factors for recurrence . Methods Prospect ively collected data of patients enrolled in the Peritoneal Surface Malignancy Program at the University of Tübingen between 2005 and 2011 were retrospectively analyzed . All patients were treated by st and ardized CRS and HIPEC . Recurrence was defined either radiographically by CT , PET-CT scan , or reoperation . Results Fifty-two patients received complete CRS ( CC-0/CC-1 ) and HIPEC .  Median time to recurrence was 229 days ( 103–1,028 ) . Overall recurrence rate within follow-up was 48 % . Of patients with recurrent disease , 44 % experienced extraperitoneal systemic tumor spread . In multivariate analysis , grading of ≥3 was shown as an independent risk factor for recurrent disease , while a trend was observed for maximal tumor load in the upper abdominal region . Clinical parameters did not show an impact on recurrence . Conclusions Primary tumor grading seems to be an independent risk factor for recurrence following complete CRS and HIPEC in colorectal cancer-derived peritoneal surface malignancies Introduction : Cytoreductive surgery ( CRS ) combined with perioperative intraperitoneal chemotherapy ( PIC ) is a treatment option for peritoneal surface malignancy . Despite the survival benefits , this treatment was previously associated with a high morbidity and mortality rates and the perception of the poor perioperative outcomes associated with this regimen remains . The aim of this study was to report the perioperative outcomes of  CRS and PIC from a single institution to review factors that are associated with a poor perioperative outcome . Methods : The clinical - and treatment-related data of 243 consecutive procedures performed were prospect ively collected and retrospectively review ed . Adverse events were rated according to the National Cancer Institute 's Common Toxicity Criteria ( grade I – V ) . Univariate and multivariate analyses were performed to identify significant clinical and treatment-related factors for a poor perioperative outcome ( grade s III/IV/V morbidity ) . Results : The perioperative mortality rate was 3 % . The rate of severe morbidity was 43 % . Multivariate analysis demonstrated that left upper quadrant peritonectomy ( P < 0.001 ) and small bowel resection ( P < 0.01 ) were factors that predicted for a poor perioperative outcome . Conclusions : The morbidity and mortality rates of CRS and PIC are within an acceptable range for a major gastrointestinal surgery which is performed with a curative intent . Patient selection is important in ensuring that suitable patients receive this treatment . A new perspective of this treatment needs to be sought PURPOSE Complete resection of macroscopic colorectal peritoneal carcinomatosis ( PC ) , followed by intraoperative intraperitoneal chemohyperthermia ( IPCH ) to treat residual microscopic disease achieves cure in some patients . We report long-term results concerning survival of a phase II study using oxaliplatin ( LOHP ) . PATIENTS AND METHODS From June 1998 to December 2003 , thirty patients with macroscopic colorectal PC underwent complete resection of PC followed by IPCH with LOHP performed in an open abdominal cavity . The dose of LOHP was 460 mg/m2 in 2 L/m2 of iso-osmotic 5 % dextrose , over 30 min at an intraperitoneally homogenous temperature of 43 degrees C and at a flow rate of 2 L/min in the continuous closed circuit . During the hour preceding IPCH , patients received 5-fluorouracil ( 400 mg/m2 ) and leucovorin ( 20 mg/m2 ) intravenously . All patients received neoadjuvant and adjuvant systemic chemotherapy . RESULTS Mean peritoneal tumor extension ( Sugarbaker 's Score ) was 14.3 + /- 3.8 , median operative duration , 450 min , and median blood loss , 940 mL. Eleven ( 37 % ) patients had associated extra-peritoneal lesions which were resected during the same procedure . There were no postoperative deaths and grade 2 - 3 morbidity ( requiring specific treatment ) was 40 % . Median follow-up was 55 months ( range : 31 - 84 ) . Twenty-two patients ( 73 % ) relapsed after a median interval of 14 months , but 7 of them ( 32 % ) were amenable to curative repeat surgery . At 3 and 5 years , overall survival rates ( 95 % confidence interval ) were 53 % ( 9 - 72 ) , and 48.5 % ( 31 - 66 ) respectively . At 3 and 5 years , disease-free survival rates were 41.5 % ( 27 - 59 ) , and 34 % ( 19 - 52 ) respectively . Median survival was 60.1 months . CONCLUSION When feasible , this treatment modality yields a 5-year survival rate of 48.5 % , with median survival attaining 60.1 months Background We conducted a phase I clinical trial to evaluate the sensitivity , specificity , and safety of cytoreductive surgery ( CRS ) under aminolevulinic acid-mediated photodynamic diagnosis ( ALA-PDD ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) on 20 patients with peritoneal carcinomatosis ( PC ) from ovarian cancer and primary peritoneal carcinoma ( PPC ) . Patients and Methods Patients took 5-aminolevulinic acid ( 5-ALA ) at a dose of 20 mg/kg orally with 50 mL of water 2 h before surgery . During surgery , the abdominal cavity was observed under blue light ( wavelength of 440 nm ) before and after CRS plus HIPEC . Specimens were excised and su bmi tted for pathological examination to evaluate the specificity of ALA-PDD . Postoperative course was closely monitored and detailed information was recorded . Results CRS under ALA-PDD plus HIPEC was performed 21 times in 20 patients with PC ( 16 ovarian cancer , 4 PPC ) between June 2011 and October 2013 . With the exception of 1 ( 5 % ) patient , strong red fluorescence was detected in 19 patients with ovarian cancer , with a sensitivity of 95 % . All specimens from red fluorescent lesions were invaded by cancer cells , with a specificity of 100 % . No severe adverse events occurred during the perioperative period , with the exception of some abnormal laboratory results and mild complications . All patients were alive until the last follow-up . Conclusion ALA-PDD provided a high sensitivity and specificity in detecting peritoneal metastasis in patients with PC from ovarian serous carcinoma and PPC .  CRS under ALA-PDD plus HIPEC was a feasible and safe treatment option for patients with PC from ovarian cancer and PPC 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 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 : After treatment of peritoneal carcinomatosis of colorectal cancer origin by cytoreduction and hyperthermic intraperitoneal chemotherapy ( HIPEC ) , recurrences develop in approximately 80 % of patients . This study evaluates the outcome of such recurrences after initial treatment by cytoreduction and HIPEC . Methods : Between November 1995 and May 2003 , 106 patients underwent cytoreduction and HIPEC .  The progression-free interval , the location of the recurrence , and its treatment were recorded . Factors potentially related to survival after recurrences were studied . Results : Sixty-nine patients had a recurrence within the study period . For patients who had undergone a gross incomplete initial cytoreduction , the median duration of survival after recurrence was 3.7 months ( st and ard error of the mean [ SE ] , .3 ) . If a complete cytoreduction had been accomplished initially , the median duration of survival after the recurrence was 11.1 months ( SE , .9 ) . A shorter interval between HIPEC and recurrence was associated with shorter survival after treatment of recurrence ( hazard ratio , .94 ; SE , .02 ) . After effective initial treatment , a second surgical debulking for recurrent disease result ed in a median survival duration of 10.3 months ( SE , 1.9 ) , and after treatment with chemotherapy it was 8.5 months ( SE , 1.6 ) . The survival was 11.2 months ( SE , .5 ) for patients who received radiotherapy for recurrent disease . Patients who did not receive further treatment survived 1.9 months ( SE , .3 ) . Conclusions : Treatment of recurrence after cytoreduction and HIPEC is often feasible and seems worthwhile in selected patients . Selection should be based mainly on the completeness of initial cytoreduction and the interval between HIPEC and recurrence BACKGROUND Evaluation of peritoneal metastases by computed tomography ( CT ) scans is challenging and has been reported to be inaccurate . METHODS A multi-institutional prospect i ve observational registry study of patients with peritoneal carcinomatosis from colorectal cancer was conducted and a subset analysis was performed to examine peritoneal cancer index ( PCI ) based on CT and intraoperative exploration . RESULTS Fifty-two patients ( mean age 52.6 ± 12.4 years ) from 16 institutions were included in this study . Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ ( P = 0.004 ) , LLQ ( P < 0.0005 ) , RLQ ( P = 0.003 ) , distal jejunum ( P = 0.004 ) , and distal ileum ( P < 0.0005 ) . When CT-PCI was classified based on the extent of carcinomatosis , 17 cases ( 33 % ) were underestimations , of which , 11 cases ( 21 % ) were upstaged from low to moderate , 4 cases ( 8 % ) were upstaged from low to severe , and 2 cases ( 4 % ) were upstaged from moderate to severe . Relevant clinical discordance where an upstage occurred to severe carcinomatosis constituted a true inaccuracy and was observed in six cases ( 12 % ) . CONCLUSIONS The actual clinical impact of inaccuracies of CT-PCI was modest . CT-PCI will remain as a m and atory imaging tool and may be supplemented with other tools including positron emission tomography scan or diagnostic laparoscopy , in the patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy 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 PURPOSE Primary cytoreductive surgery ( CRS ) and peri-operative intraperitoneal chemotherapy ( PIC ) is the only curative option for patients with colorectal cancer peritoneal carcinomatosis ( PC ) . A significant proportion of patients develop peritoneal recurrence . Outcomes of patients undergoing secondary CRS and PIC for recurrent PC were examined . METHODS All patients undergoing second procedures with curative intent for recurrent appendiceal or colorectal cancer PC in three centers were included . Patients with recurrent pseudomyxoma peritonei ( PMP ) were excluded .  Morbidity and mortality , overall survival , and disease-free survival were primary outcome parameters . RESULTS The study included 18 patients ( 13 colorectal and 5 appendiceal cancer ) . At primary CRS , mean Peritoneal Cancer Index ( PCI ) was 9.1 . In 13 patients complete resection was achieved . Median time to recurrence was 14 months ( range : 1 - 33 ) . At secondary CRS , mean PCI was 6.3 and CRS was complete in 13 patients . There was no 30-day mortality and 1- and 2-year survival were 74 % and 50 % , respectively . In 14 patients a recurrence after the second procedure was diagnosed . CONCLUSIONS A secondary CRS for recurrent colorectal or appendiceal cancer PC is safe and feasible , however , relapse is frequent . Further investigations are required to critically assess the efficacy of a secondary procedure and to define optimal patient selection criteria in the era of effective modern chemotherapy 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 PURPOSE In patients with peritoneal carcinomatosis ( PC ) , cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) is an evolving therapeutic approach with curative intention . The differentiation between posttherapeutic findings after HIPEC and relapse of PC is challenging . We evaluated the diagnostic value of F-18-FDG-PET/CT in patients with relapse of PC after HIPEC . MATERIAL S AND METHODS 36 patients with recurring PC after HIPEC were examined on a whole-body  PET/CT system ( 44 examinations ) . The examination included 3 D F-18-FDG-PET and contrast-enhanced CT . Images were assessed by two experienced readers regarding the presence and the extent of PC using the peritoneal carcinomatosis index ( PCI ) . Imaging results were correlated with surgical findings or follow-up . RESULTS Relapse was suspected in 40 of 44 examinations . Relapse was missed by F-18-FDG PET/CT in 4 patients and significantly underestimated in 8 patients . The diagnostic accuracy for the detection of PC on a patient basis was 91 % , the sensitivity was 91 % and the positive predictive value was 100 % . The mean PCI was 11.4 ± 11.9 for PET/CT , 8.4 ± 10.3 for CT and 16.6 ± 15.0 in the case of surgical exploration . The extent of PC was underestimated by PET/CT and even more by CT alone ( p < 0.05 ) . CONCLUSION The diagnostic value of F-18-FDG PET/CT after cytoreductive surgery and HIPEC in the detection of recurring PC is superior to contrast-enhanced CT . However , the quantification of the extent of PC is limited due to post-therapeutic tissue alterations . KEY POINTS • Imaging of recurrent PC after HIPEC is challenging due to posttherapeutic tissue alterations.• The extent of recurrent PC after HIPEC is systematic ally underestimated by F-18-FDG PET/CT.• F-18-FDG PET/CT provides improved sensitivity for recurrent PC compared to contrast-enhanced CT.• The correlation of the extent of recurrent PC depicted by F-18-FDG PET/CT and surgical exploration is better than that of contrast-enhanced CT and surgical exploration Background This study aim ed to investigate the impact of postoperative complications on long-term survival and disease recurrence in patients who underwent curative resection for colorectal cancer . Method Patients who underwent radical resection for colorectal cancer with curative intent from January 1996 to December 2004 were included .  Operative mortality and morbidity were documented prospect ively . Factors that might affect long-term outcome were analyzed with multivariate analysis . Results Curative resection was performed in 1657 patients ( 943 men ) , and the median age was 70 years ( range : 24–94 years ) . The 30-day mortality was 2.4 % , and the complication rate was 27.3 % . Age over 70 years ( P < .001 , odds ratio : 2.06 , 95 % CI : 1.63–2.61 ) , male gender ( P = .001 , odds ratio : 1.49 , 95 % CI : 1.19–1.88 ) , emergency operation ( P < .001 , odds ratio : 3.14 , 95 % CI : 2.26–4.35 ) and rectal cancer ( P < .001 , odds ratio : 1.41 , 95 % CI : 1.25–1.61 ) were associated with a significantly higher complication rate . With exclusion of patients who died within 30 days , the median follow-up of the surviving patients was 45.3 months . The 5-year overall survival was 64.9 % , and the overall recurrence rate was 29.1 % . The presence of postoperative complications was an independent factor associated with a worse overall survival ( P = .023 , hazard ratio : 1.26 ; 95 % CI : 1.03–1.52 ) and a higher overall recurrence rate ( P = .04 , hazard ratio : 1.26 ; 95 % CI : 1.01–1.57 ) . Conclusion The presence of postoperative complication not only affects the short-term results of resection of colorectal cancer , but the long-term oncologic outcomes are also adversely affected . Long-term outcomes can be improved with efforts to reduce postoperative complications Background : Although a r and omized trial demonstrated a survival benefit of cytoreductive surgery ( CRS ) and intraperitoneal chemotherapy ( IPC ) over systemic chemotherapy alone , the treatment of peritoneal carcinomatosis from colorectal cancer ( CRPC ) is still a matter of debate . The aims of this study were to evaluate long-term outcome after CRS and IPC and to identify the prognostic factors associated with a cure . Methods : Patients were considered cured if the disease-free survival interval lasted at least 5 years after the treatment of CRPC or its last recurrence . Patients who had died postoperatively , or from non – cancer-related deaths , or patients with a follow-up of less than 5 years since the last curative treatment were excluded from the analysis . Results : From 1995 to 2006 , 107 patients ( median age , 48 years ; range , 19–67 years ) underwent complete CRS , followed by IPC .  Postoperative complications occurred in 50 patients ( 53 % ) , including 4 postoperative deaths . After a median follow-up of 77 months ( range , 60–144 months ) , 5-year and 10-year overall survival rates were 35 % and 15 % , respectively . Seventeen patients ( 16 % ) were considered cured after a disease-free interval of at least 5 years , of whom 14 never developed a recurrence . Cured patients had a significantly lower median peritoneal cancer index than noncured patients , respectively 4 ( 3–16 ) and 12 ( 2–36 ) ( P = 0.0002 ) . In multivariate analysis , a peritoneal cancer index of 10 or less was the only independent factor predicting cure . Conclusions : The cure rate ( 16 % ) after complete CRS of colorectal peritoneal carcinomatosis , followed by IPC , in selected patients is close to that obtained after resection of colorectal liver metastases 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 The optimal treatment for peritoneal carcinomatosis ( PC ) of colorectal origin is a combination of cytoreductive surgery and intraperitoneal chemotherapy ( CRS + IPC ) .
Although 5-year survival rates of up to 40 % have been reported , recurrent disease remains common and is estimated to be a strong negative prognostic factor for survival .
This systematic review elaborates on the incidence of recurrent disease and the possibilities to prevent and treat recurrence .