Cytoreductive approach to peritoneal carcinomatosis originated from colorectal cancer: Turkish experience. Aggressive Surgical Management of Peritoneal Carcinomatosis With Low Mortality in a High-Volume Tertiary Cancer Center Prognostic Features of 51 Colorectal and 130 Appendiceal Cancer Patients with Peritoneal Carcinomatosis Treated by Cytoreductive Surgery and Intraperitoneal Chemotherapy Critical Analysis of Treatment Failure After Complete Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Dissemination From Appendiceal Mucinous Neoplasms Optimization of Hyperthermic Intraperitoneal Chemotherapy With Oxaliplatin Plus Irinotecan at 43°C After Compete Cytoreductive Surgery: Mortality and Morbidity in 106 Consecutive Patients Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis Arising From Colon Adenocarcinoma Cytoreductive Surgery Combined with Intraperitoneal Chemohyperthermia for the Treatment of Advanced Colon Cancer Treatment of primary colon cancer with peritoneal carcinomatosis Treatment of Peritoneal Carcinomatosis From Colorectal Cancer: Impact of Complete Cytoreductive Surgery and Difficulties in Conducting Randomized Trials Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin. Comparison of Two Kinds of Intraperitoneal Chemotherapy Following Complete Cytoreductive Surgery of Colorectal Peritoneal Carcinomatosis Peritioneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis. Long-Term Survival of Peritoneal Carcinomatosis of Colorectal Origin Predicting the survival of patients with peritoneal carcinomatosis of colorectal origin treated by aggressive cytoreduction and hyperthermic intraperitoneal chemotherapy Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy With Mitomycin C for Peritoneal Carcinomatosis from Nonappendiceal Colorectal Carcinoma Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma: non-mucinous tumour associated with an improved survival. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Isolated Colorectal Peritoneal Carcinomatosis: Experimental Therapy or Standard of Care? Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin.
Peritoneal carcinomatosis ( PC ) in contrast to lymph nodes and liver metastases was assumed as a terminal condition with no curative treatment options having a 5 to 9 months median survival rate until recently . Today , in properly selected patients , curative surgical treatment of PC is possible like resection of lymph nodes and liver metastases . Between 1996 and 2005 , 29 patients who underwent cytoreductive surgery combined with intraperitoneal chemotherapy for PC originated from colorectal cancer ( CRC ) were analysed prospect ively at the Department of Surgery in Dokuz Eylul University Hospital . Mean age was 54 year ( range , 23 - 75 years ) . There was no peroperative mortality in 29 patients . The morbidity rate was 41 % ( 12/29 ) and 6 ( 20 % ) patients required reoperation(s ) for major complications . Mean and median survival time was 34 and 21 months , respectively . The overall 1-year , 3-year , and 5-year survival rates were 72 % , 13 % , and 7 % , respectively . Mean survival time was 56 months in patients with peritoneal cancer index ( PCI ) < 10 , and 22 months in patients with PCI > 10 ( P = 0.075 ) . The mean survival time was 62 months in patients with complete cytoreduction (CC)-0 score , 21 months in patients with CC-1 score , and 7 months in patients with CC-2 and 3 scores . Patients who had CC-0 score had better survival than patients having CC-1 and CC-2 scores ( P = 0.003 and P = 0.000 , respectively ) . Patients who had CC-0 and 1 scores had better survival than patients with CC-2 score ( P = 0.000 ) . The overall 1-year , 3-year , and 5-year survival rates for patients with CC-0 score were 87 % , 37 % , and 25 % , respectively . There was a positive correlation between the PCI and CC score ( P = 0.001 , correlation coefficient = 0.585 with correlation is significant at level 0.01 ) . Cytoreductive approach combined with intraperitoneal chemotherapy and systemic chemotherapy prolongs survival in selected patients with PC of CRC with acceptable morbidity and mortality . Prognosis is better in patients with limited disease and in whom complete cytoreduction is achieved . In patients with PC of CRC , the key issue is to select the patients in whom complete cytoreduction is feasible . Better patient assessment with new diagnostic tools such as (PET)-CT or PET-magnetic resonance imaging will be used to detect more precisely the patients with low tumor burden in the new feature 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 Objective A treatment plan to be used in patients with peritoneal carcinomatosis was devised and tested as a Phase II study . Background Background carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity . Treatment protocol s have not been reported previously . Methods The authors used cytoreductive surgery and intraperitoneal chemotherapy to treat 181 consecutive patients with peritoneal carcinomatosis . There were 51 patients with colorectal cancer and 130 patients with appendiceal cancer . Mean follow-up is 24 months , with a range of 0 to 149 months . Results Results features that showed prognostic significance included appendiceal versus colorectal primary tumors ( p = 0.0001 ) , grade 1 versus grade s 2 and 3 histopathology ( p = 0.0003 ) , complete versus incomplete cytoreductions ( p = 0.0001 ) , lymph node-negative versus lymph node-positive primary tumors ( p = 0.0001 ) , and volume of peritoneal carcinomatosis present preoperatively for colon cancer ( p = 0.0006 ) . Features with no statistical prognostic significance included preoperative tumor volume for appendiceal cancer , age , sex , number of cycles of chemotherapy , operative time , complications , blood loss , and institution providing treatment . From these prognostic features , four prognostic groups were identified , and 3-year survival was estimated by the product-limit survival method . Group I patients ( n = 76 ) were those with grade 1 histology , no lymph node metastases , and complete cytoreductions ( survival at 3 years = 99 % ) . Group II patients ( n = 23 ) were those with grade 2 or 3 histology , no lymph node metastases , and complete cytoreductions ( 65 % ) . Group III patients ( n = 24 ) had any histology , lymph node metastases , and complete cytoreductions ( 66 % ) . Group IV patients ( n = 58 ) had incomplete cytoreductions ( 20 % ) . Conclusions Conclusions cacinomatosis is a treatable condition in selected patients with the possibility for longterm , disease-free survival Background Cytoreductive surgery ( CRS ) combined with perioperative intraperitoneal chemotherapy ( PIC ) has been suggested as a treatment strategy for peritoneal carcinomatosis . The objective of this data analysis was to study treatment failure after complete cytoreduction for peritoneal dissemination from appendiceal mucinous neoplasms . Methods Before June 2006 , a total of 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute . Patient characteristics , pathologic features , and treatment-related data were obtained from a prospect i ve data base . Survival analyses were performed by the Kaplan-Meier method and the Cox regression model . Results After a median follow-up of 66 months , the 5- and 10-year progression-free survival rates for these 402 patients were 70 % and 67 % , respectively . Disease progression was the only independent risk factor for a reduced overall survival . One hundred eleven patients ( 28 % ) developed progressive disease . Of these , 98 patients underwent second-time and 26 patients third-time CRS and PIC . Complete cytoreduction after repeat surgery was the only independent prognostic factor for improved survival . The most common sites of treatment failure were on the small bowel and in the pelvis . Conclusions The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease-free state is important for long-term survival in peritoneal dissemination from appendiceal mucinous neoplasms . Repeat complete cytoreduction should be pursued when possible and is associated with improved overall survival in patients with recurrent disease Background Peritoneal carcinomatosis ( PC ) , which has hitherto been regarded as a lethal entity , can now be cured with surgery ( treating macroscopic tumor seeding ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) ( treating residual microscopic disease ) . The purpose of this study was to analyze the morbidity and mortality of a particular approach associating optimal ( R0–R1 ) cytoreduction , optimal HIPEC combining oxaliplatin and irinotecan , and an optimal homogeneous intraperitoneal temperature of 43 ° C . Methods A total of 106 consecutive patients were included in this prospect i ve phase 2 study . After complete resection of the PC , HIPEC was performed by the Coliseum technique with oxaliplatin ( 360 mg/m2 ) combined with irinotecan ( 360 mg/m2 ) in 2 L/m2 of 5 % dextrose , over 30 minutes at a real intraperitoneal temperature of 43 ° C . During the hour preceding HIPEC , patients received 5-fluorouracil ( 400 mg/m2 ) and leucovorin ( 20 mg/m2 ) intravenously , result ing in tritherapy . Results Postoperative mortality and morbidity rates were 4 % and 66 % , respectively . The most frequent complications were digestive fistula ( 24 % ) , lung infection ( 16 % ) , and severe hematological toxicity ( 11 % ) . Statistical correlation was evidence d between morbidity and the carcinomatosis score ( P = .0008 ) , the number of resected organs ( P = .0001 ) , the duration of surgery ( P = .0001 ) , and blood loss ( P = .0001 ) . Conclusions This new approach , optimized in three respects ( complete cytoreduction , combination oxaliplatin with irinotecan , and high temperature ) has result ed in a relatively high but acceptable incidence of adverse events considering the expected advantage for survival 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 PURPOSE : The initial dissemination of colon cancer occurs through three routes : the lymphatics , the portal blood , and the peritoneal surfaces . Although lymphatic and hematogenous metastases indicate an aggressive disease process , it is possible that dissemination to peritoneal surfaces may be only superficial contamination of the parietal and visceral peritoneum that may be treatable for cure . Unfortunately , surgery may have an adverse impact on peritoneal surface dissemination . Surgical interventions may convert a superficial process into an invasive condition with a greatly reduced prognosis . This study was conducted to test this hypothesis by the use of data prospect ively recorded from patients treated for peritoneal carcinomatosis concomitant with resection of the primary colon cancer or treated for carcinomatosis after disease recurrence prompted referral . METHODS : Our first group of patients had definitive treatment of carcinomatosis simultaneous with resection of the primary colon cancer . They had cytoreductive surgery including peritonectomy procedures followed by heated intraoperative intraperitoneal chemotherapy with mitomycin C plus early postoperative intraperitoneal 5-fluorouracil . The comparison group was treated with a colon resection at an outside hospital and then later referred to us with progressive disease for treatment . The major difference between the groups is the timing of the definitive treatment of carcinomatosis . These patients were also studied by use of the completeness of the cytoreduction score and the peritoneal cancer index as prognostic indicators . Survival was the end point for all the analysis . RESULTS : Of 104 patients with peritoneal carcinomatosis from colon or rectal adenocarcinoma , five patients ( 4.8 percent ) had definitive treatment of the peritoneal surface spread of the cancer concomitant with resection of the primary lesion . Median survival for these patients has not been reached and their five-year survival rate is 100 percent . The remainder of the patients ( n=99 ) were referred for local and regional recurrence after their primary cancer had been removed and there was progression of carcinomatosis . Forty-four patients ( 42.3 percent ) had a complete cytoreduction result ing in a 24-month median survival and a 30 percent five-year survival ( P<0.0001 ) . The other 55 patients ( 52.9 percent ) had an incomplete cytoreduction result ing in a 12-month median survival and a 0 percent five-year survival ( P<0.0001 ) . Patients with a peritoneal cancer index of 10 or less had a 48-month median survival and a 50 percent five-year survival rate . Patients with a peritoneal cancer index between 11 and 20 had a 24-month median survival and a 20 percent five-year survival rate ( P<0.0001 ) . Patients with a peritoneal cancer index of more than 20 had a 12-month median survival and a 0 percent five-year survival ( P<0.0001 ) . CONCLUSIONS : In patients with peritoneal seeding occurring at the time of resection of the primary malignancy , peritonectomy procedures and perioperative intraperitoneal chemotherapy should be performed concomitantly . By use of a quantitative scoring system , the mass of cancer present in the abdomen and pelvis at the time of treatment of carcinomatosis correlated directly with survival . Aggressive treatment of patients with peritoneal carcinomatosis requires consideration in the management of colorectal cancer 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 BACKGROUND Although lymph node and liver metastases are recognized as indications for resection of metastatic disease from colorectal cancer , carcinomatosis has not traditionally been regarded as having surgical treatment options . Reports have suggested that complete surgical removal of carcinomatosis combined with thorough irrigation of the peritoneal cavity with chemotherapy could result in longterm survival in selected patients . Proper selection factors are important because palliative surgery in these patients has not proved beneficial . STUDY DESIGN From a data base of 156 patients with carcinomatosis from colorectal cancer , a retrospective analysis of data prospect ively recorded in 70 patients with complete cytoreduction was performed . Eleven clinical and treatment factors were studied in univariate and multivariable analyses using survival as an end point . RESULTS By univariate analysis , patients with peritoneal cancer index ( PCI ) of<20 had a median survival of 41 months compared with 16 months for patients with PCI>20 ( p=0.004 ) . The difference in negative versus positive lymph nodes was also significant ; differences in survival that were improved but not significant were present for age greater than 30 years , mucinous histology , location within the colon versus rectum , and absence of an adverse factor such as cancer perforation or obstruction present at the time of primary cancer resection . Only PCI<20 versus PCI>20 and lymph node status were significant in the multivariable analysis . CONCLUSIONS Favorable longterm results of complete cytoreduction in patients treated for carcinomatosis are associated with a limited volume of carcinomatosis observed at the time of cytoreduction and in patients with negative lymph nodes at the time of primary operation 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 HYPOTHESIS Certain clinicopathologic factors predict improved survival after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis . DESIGN Prospect i ve clinical trial . SETTING Surgical oncology service at a university academic hospital . PATIENTS A population of 109 consecutive patients with peritoneal carcinomatosis treated between December 1991 and November 1997 . INTERVENTION All patients underwent resection of gross disease followed by 2-hour intraoperative perfusion of mitomycin C ( 20 - 40 mg ) into the peritoneal cavity at a temperature of 40.5 degrees C. MAIN OUTCOME MEASURES Clinicopathologic factors that independently predicted improved overall survival rates . RESULTS Overall survival at 1 and 3 years was 61 % and 33 % , respectively . With median follow-up of 52 months , median overall survival was 16 months . Four factors were significant independent predictors of improved survival by multivariate analysis : nonadenocarcinoma histologic features ( P = .001 ) , the appendix as a primary site ( P = .003 ) , the absence of hepatic parenchymal metastases ( P = .01 ) , and complete resection of all gross disease ( R1/0 resection ) ( P<.001 ) . Patients with an R1/0 resection vs an incomplete resection of gross disease ( R2 resection ) had 3-year overall survival of 68 % vs 21 % ( P<.001 ) . CONCLUSIONS Patients with peritoneal carcinomatosis have a uniformly poor prognosis . However , in select patients , the natural history of this disease condition may be altered by using the multimodality approach of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy . These results require confirmation in prospect i ve r and omized studies 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 Peritoneal carcinomatosis in the absence of distant metastasis occurs in approximately 8 per cent of patients with colorectal cancer .  Cytoreduction followed by hyperthermic intraperitoneal chemotherapy ( HIPEC ) is a new treatment option . Patient selection is crucial to outcome 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 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 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 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 %
Background The objective of the present meta- analysis was to analyze the survival outcomes of patients with colorectal peritoneal carcinomatosis ( CRPC ) , with particular focus on cytoreductive surgery ( CRS ) and perioperative intraperitoneal chemotherapy ( PIC ) .