nach oben

Annals of Surgical Oncology

Erschienen in:

01.08.2009 | Gastrointestinal Oncology

A Systematic Review and Meta-Analysis of Cytoreductive Surgery with Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin

verfasst von: Christopher Cao, MBBS, Tristan D. Yan, PhD, Deborah Black, PhD, David L. Morris, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2009

Einloggen, um Zugang zu erhalten

Abstract

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).

Methods

A search was conducted on Medline from 1950 to February 2009 and Pubmed from 1950 to February 2009 for original studies on CRS with PIC. All articles included in this study were assessed with the application of predetermined selection criteria. Results regarding the overall survival in the meta-analysis were expressed as hazard ratios with 95% confidence intervals.

Results

Forty-seven manuscripts were selected in the present systematic review, including 4 comparative studies and 43 observational studies of CRS with PIC. From the meta-analysis, it can be seen that a significant improvement in survival was associated with treatment by CRS and hyperthermic intraperitoneal chemotherapy compared with palliative approach (P < 0.0001). The pooled data did not show a significant improvement in overall survival for patients treated by CRS and early postoperative intraperitoneal chemotherapy versus surgery and systemic chemotherapy (P = 0.35). The overall effect of PIC is significantly better than the control group (P = 0.0002). The current literature suggests that patients with liver metastasis amendable to resection should not be excluded from CRS and PIC. However, there is a need for further evaluation of the prognostic significance of lymph node and liver involvement, ideally in large prospective trials.

Conclusions

The meta-analysis showed that combined therapy involving CRS and PIC had a statistically significant survival benefit over control groups.

Jayne DG, Fook S, Loi, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer Br J Surg. 2002;89:1545–50.PubMedCrossRef

Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors Cancer. 1989;63:364–7.PubMedCrossRef

Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study Cancer. 2000;88:358–63.PubMedCrossRef

de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer J Clin Oncol. 2000;18:2938–47.PubMed

Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal origin J Clin Oncol. 2003;21:3737–43.PubMedCrossRef

Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials Ann Surg Oncol. 2004;11:518–21.PubMedCrossRef

Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin J Clin Oncol. 2009;27(5):681–5.PubMedCrossRef

Mahteme H, Hansson J, Berglund A, et al. Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study Br J Cancer. 2004;90:403–7.PubMedCrossRef

Elias D. French multi-institutional registry for colorectal peritoneal carcinomatosis. 5th peritonectomy workshop. Lyon, France. Oct 2008. Abstract.

10.

Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study J Clin Oncol. 2004;22:3284–92.PubMedCrossRef

11.

Gomez Portilla A. Barrios P, Rufian S, et al. Management of peritoneal surface malignancy with cytoreductive surgery and perioperative intraperitoneal chemotherapy Eur J Surg Oncol. 2006;32(6):628–31.PubMedCrossRef

12.

Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy Ann Surg. 1995;221:124–32.PubMed

13.

Sugarbaker PH, Schellinx MET, Chang D, Koslowe P, von Meyerfeldt M. Peritoneal carcinomatosis from adenocarcinoma of the colon World J Surg. 1996;20:585–92.PubMedCrossRef

14.

Pestieau SR, Sugarbaker PH. Treatment of primary colon cancer with peritoneal carcinomatosis: comparison of concomitant vs.. delayed management Dis Colon Rectum. 2000;43:1341–8.PubMedCrossRef

15.

Carmignani CP, Ortega-Perez G, Sugarbaker PH. The management of synchronous peritoneal carcinomatosis and hematogenous metastasis from colorectal cancer Eur J Surg Oncol. 2004;30:391–8.PubMedCrossRef

16.

Gomes da Silva RG, Sugarbaker PH. Analysis of 10 prognostic factors in 70 patients having complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis from colorectal cancer J Am Coll Surg. 2006; 203(6):878–86.CrossRef

17.

Beaujard AC, Glehen O, Caillot JL, et al. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis Cancer. 2000;88:2512–19.PubMedCrossRef

18.

Glehen O, Cotte E, Schreiber V, Sayag-Beaujard AC, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin Br J Surg. 2004;91:747–54.PubMedCrossRef

19.

Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy Cancer. 2001;92:71–6.PubMedCrossRef

20.

Elias D, Pocard M, Sideris L, Ede C, Ducreux M, Boige V, Lasser P. Preliminary results of intraperitoneal chemohyperthermia with oxaliplatin in peritoneal carcinomatosis of colorectal origin Br J Surg. 2004;91:455–6.PubMedCrossRef

21.

Elias D, Raynard B, Farkhondeh F, et al. Peritoneal carcinomatosis of colorectal origin: long-term results of intraperitoneal chemohyperthermia with oxaliplatin following complete cytoreductive surgery Gastroenterol Clin Biol. 2006;30(10):1200–4.PubMed

22.

Elias D, Benizri E, DiPietrantonio D, Menegon P, Malka D, Raynard B. Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis Ann Surg Oncol. 2007;14(2):509–14.PubMedCrossRef

23.

Elias D, Goere D, Blot F, Billard V, Pocard M, Kohneh-Shahri N, et al. Optimization of hyperthermic intraperitoneal chemotherapy with oxaliplatin plus irinotecan at 43 degrees C after compete cytoreductive surgery: mortality and morbidity in 106 consecutive patients Ann Surg Oncol. 2007;14(6):1818–24.PubMedCrossRef

24.

Witkamp AJ, de Bree E, Kaag MM, et al. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin C in patients with peritoneal carcinomatosis of colorectal origin Eur J Cancer. 2001;37:979–84.PubMedCrossRef

25.

Verwaal VJ, van Tinteren H, van Ruth S, Zoetmulder FA. Predicting the survival of patients with peritoneal carcinomatosis of colorectal origin treated by aggressive cytoreduction and hyperthermic intraperitoneal chemotherapy Br J Surg. 2004;91:739–46.PubMedCrossRef

26.

Verwaal VJ, van Ruth S, Witkamp A, Boot H, van Slooten G, Zoetmulder F. Long-term survival of peritoneal carcinomatosis of colorectal origin Ann Surg Oncol. 2005;12:65–71.PubMedCrossRef

27.

Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin Am Surg. 2000;66:561–8.PubMed

28.

Shen P, Levine EA, Hall J, et al. Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis Arch Surg. 2003;138:26–33.PubMedCrossRef

29.

Shen P, Hawksworth J, Lovato J, Loggie BW, Geisinger KR, Fleming RA, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma Ann Surg Oncol. 2004;11:178–86.PubMedCrossRef

30.

Levine EA, Stewart JH 4th, Russell GB, Geisinger KR, Loggie BL, Shen P. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures J Am Coll Surg. 2007;204(5):943–53; discussion 953–5.PubMedCrossRef

31.

Shen P, Thai K, Stewart JH, Howerton R, Loggie BW, Russell GB, et al. Peritoneal surface disease from colorectal cancer: comparison with the hepatic metastases surgical paradigm in optimally resected patients Ann Surg Oncol. 2008;15(12):3422–32.PubMedCrossRef

32.

Cavaliere F, Valle M, De Simone M, et al. 120 peritoneal carcinomatoses from colorectal cancer treated with peritonectomy and intra-abdominal chemohyperthermia: a S.I.T.I.L.O. multicentric study In Vivo. 2006;20(6A):747–50.PubMed

33.

Cavaliere F, Perri P, Di Filippo F, et al. Treatment of peritoneal carcinomatosis with intent to cure J Surg Oncol. 2000;74:41–4.PubMedCrossRef

34.

Cavaliere F, Di Filippo F, Botti C, et al. Peritonectomy and hyperthermic antiblastic perfusion in the treatment of peritoneal carcinomatosis Eur J Surg Oncol. 2000;26(5):486–91.PubMedCrossRef

35.

Hadi R, Saunders V, Utkina O, Clingan P, Kam P, Links M, et al. Review of patients with peritoneal malignancy treated with peritonectomy and heated intraperitoneal chemotherapy ANZ J Surg. 2006;76(3):156–61.PubMedCrossRef

36.

Yan TD, Chu F, Links M, Kam PC, Glenn D, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma: non-mucinous tumour associated with an improved survival Eur J Surg Oncol. 2006;32(10):1119–24.PubMedCrossRef

37.

Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg. 2008;248(5):829–35.PubMed

38.

Schneebaum S, Arnold MW, Staubus A, Young D, Dumond D, Martin EW. Intraperitoneal hyperthermic perfusion with mitomycin C for colorectal cancer with peritoneal metastases Ann Surg Oncol. 1996;3:44–50.PubMedCrossRef

39.

Pilati P, Mocellin S, Rossi CR, et al. Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma Ann Surg Oncol. 2003;10:508–13.PubMedCrossRef

40.

Kecmanovic DM, Pavlov MJ, Ceranic MS, Sepetkovski AV, Kovacevic PA, Stamenkovic AB. Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic perioperative intraperitoneal chemotherapy Eur J Surg Oncol. 2005;31:147–52.PubMedCrossRef

41.

Zanon C, Bortolini M, Chiappino I, et al. Cytoreductive surgery combined with intraperitoneal chemohyperthermia for the treatment of advanced colon cancer World J Surg. 2006;30(11):2025–32.PubMedCrossRef

42.

Roviello F, Marrelli D, Neri A, et al. Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity World J Surg. 2006;30(11):2033–40; discussion 2041–2.PubMedCrossRef

43.

Fuzun M, Sokmen S, Terzi C, Canda AE. Cytoreductive approach to peritoneal carcinomatosis originated from colorectal cancer: Turkish experience Acta Chirurgica Iugoslavica. 2006;53(2):17–21.PubMedCrossRef

44.

Kianmanesh R, Scaringi S, Sabate J, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases Ann Surg. 2007;245(4):597–603.PubMedCrossRef

45.

van Leeuwen BL, Graf W, Pahlman L, Mahteme H. Swedish experience with peritonectomy and HIPEC. HIPEC in peritoneal carcinomatosis Ann Surg Oncol. 2008;15(3):745–53.PubMedCrossRef

46.

Hansson J, Graf W, Påhlman L, Nygren P, Mahteme H. Postoperative adverse events and long-term survival after cytoreductive surgery and intraperitoneal chemotherapy Eur J Surg Oncol. 2009;35(2):202–8.PubMed

47.

Gusani NJ, Cho SW, Colovos C, et al. Aggressive surgical management of peritoneal carcinomatosis with low mortality in a high-volume tertiary cancer center Ann Surg Oncol. 2008;15(3):754–63.PubMedCrossRef

48.

Franko J, Gusani NJ, Holtzman MP, Ahrendt SA, Jones HL, Zeh HJ 3rd, et al. Multivisceral resection does not affect morbidity and survival after cytoreductive surgery and chemoperfusion for carcinomatosis from colorectal cancer Ann Surg Oncol. 2008;15(11):3065–72.PubMedCrossRef

49.

Ceelen WP, Peeters M, Houtmeyers P, et al. Safety and efficacy of hyperthermic intraperitoneal chemoperfusion with high-dose oxaliplatin in patients with peritoneal carcinomatosis Ann Surg Oncol. 2008;15(2):535–41.PubMedCrossRef

50.

Hagendoorn J, van Lammeren G, Boerma D, van der Beek E, Wiezer MJ, van Ramshorst B. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal and gastrointestinal origin shows acceptable morbidity and high survival Eur J Surg Oncol. 2008 [Epub ahead of print].

51.

Akaishi E, Teixeira F, Katayama M, Mizumoto N, Costa FP, Buzaid AC, et al. Peritonectomy for peritoneal carcinomatosis: long-term outcomes from a single Brazilian institution World J Surg. 2009;33(4):835–9.PubMedCrossRef

52.

Sugarbaker PH. Peritonectomy procedure Ann Surg. 1995;221:29–42.PubMed

53.

CEBM (2009) Levels of evidence. Oxford Centre for Evidence-Based Medicine. Available: http://www.cebm.net/index.aspx?o=1025 [Accessed: 25 March 2009].

54.

Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints Stat Med. 1998;17:2815–34.PubMedCrossRef

55.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis Stat Med. 2002;21:1539–58.PubMedCrossRef

56.

Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role Langenbecks Arch Surg. 1999;384:576–87.PubMedCrossRef

57.

Sugarbaker PH. Review of a personal experience in the management of carcinomatosis and sarcomatosis Jpn J Clin Oncol. 2001;31:573–83.PubMedCrossRef

58.

Koppe MJ, Boerman OC, Oyen W, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin incidence and current treatment strategies Ann Surg. 2006;243:212–22.PubMedCrossRef

59.

Yan TD, Bijelic L, Sugarbaker PH. Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms Ann Surg Oncol. 2007;14:2289–99.PubMedCrossRef

60.

Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer Cancer Chemother Pharmacol. 1999;43:S15–25.PubMedCrossRef

61.

Benoit L, Duvillard C, Rat P, Chauffert B. The effect of intra-abdominal temperature on the tissue and tumor diffusion of intraperitoneal cisplatin in a model of peritoneal carcinomatosis in rats Chirurgie. 1999;124:375.PubMedCrossRef

62.

Sugarbaker PH. Clinical research to standard of care: when does the transition occur? Ann Surg Oncol. 2003;10:825–6.PubMedCrossRef

63.

Lefor AT, Hughes KS, Shiloni E, et al. Intra-abdominal extrahepatic disease in patients with colorectal hepatic metastases Dis Colon Rectum. 1988;31:100–3.PubMedCrossRef

Titel: A Systematic Review and Meta-Analysis of Cytoreductive Surgery with Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin
verfasst von: Christopher Cao, MBBS
Tristan D. Yan, PhD
Deborah Black, PhD
David L. Morris, PhD
Publikationsdatum: 01.08.2009
Verlag: Springer-Verlag
Erschienen in: Annals of Surgical Oncology / Ausgabe 8/2009
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0487-4

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2009

Safety of Gastric Resections During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

Unraveling Breast Cancer Heterogeneity Through Transcriptomic and Epigenomic Analysis

Evolving Treatment Strategies for Gallbladder Cancer

Limb-Sparing Resection of the Scapula and Reconstruction with a Constrained Total Scapula Prosthesis: A Case of Multicentric Epithelioid Hemangioendothelioma Involving the Scapula and Surrounding Soft Tissues

Polymorphisms in the Hypoxia Inducible Factor 1-α and the Impact on the Prognosis of Early Stages of Oral Cancer

When Is Prophylactic Thyroidectomy Indicated for Patients with the RET Codon 609 Mutation?

Update Chirurgie