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The peritoneum is the second most common site for metastasis in patients with colorectal cancer. Various factors have been studied to identify patients at risk of developing peritoneal carcinomatosis (PC), including T4 tumors. The objectives were to assess the incidence of synchronous and metachronous PC, explore potential risk factors for developing PC as the only site of metastasis, and identify which patients might be candidates for prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC).
We conducted a retrospective analysis of 125 patients with pT4 colon cancer who underwent surgery in a single center between January 2010 and December 2014.
Of the 947 colon cancer patients who underwent surgery, 125 (13.2%) were diagnosed with pT4a or b colon carcinoma. The median follow-up was 3.7 years. The overall rate of PC was 34.3%, being synchronous in 12% and metachronous in 22.3% of cases. The 8% and 6% of synchronous and metachronous cases of PC respectively were isolated (single site) metastasis. The incidence of PC was 6.1% at 1 year and 14.5% at 3 years after surgery. pT4 was not found to be an independent risk factor for the development of PC (p = 0.231). Nonetheless, the rate of metachronous PC as a single site of metastasis was higher in patients with pT4 tumors and peritoneal nodules around the primary tumor and/or tumor perforation (p = 0.027) and/or who underwent emergency surgery (p = 0.043) than other patients.
Considering pT4 tumor stage as the only risk factor for the development of PC in deciding whether to administer prophylactic HIPEC would lead to unjustified overtreatment.
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86. CrossRef
Brodsky JT, Cohen AM. Peritoneal seeding following potentially curative resection of colonic carcinoma: implications for adjuvant therapy. Dis Colon Rectum. 1991;34:723–7. CrossRef
Elferink MAG, de Jong KP, Klaase JM, et al. Metachronous metastases from colorectal cancer: a population-based study in North-East Netherlands. Int J Colorectal Dis. 2015;30:205–12. CrossRef
Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89(12):1545–50. CrossRef
Glehen O, Osinsky D, Beaujard AC, et al. Natural history of peritoneal carcinomatosis from nongynecologic malignancies. Surg Oncol Clin N Am. 2003;12(3):729–39. CrossRef
Sugarbaker PH, Cunliffe WJ, Belliveau J, et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol. 1989;16(4 Suppl 6):83–97. PubMed
Minsky BD, Mies C, Rich TA, et al. Potentially curative surgery of colon cancer: patterns of failure and survival. J Clin Oncol. 1988;6(1):106–18. CrossRef
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(16):3284–92. CrossRef
Esquivel J, Elias D, Baratti D, et al. Consensus statement on the locoregional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol. 2008;98(4):263–7. CrossRef
Cortes-Guiral D, Elias D, Cascales-Campos PA, et al. Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis: does it really save lives? World J Gastroenterol. 2017;23(3):377–81. CrossRef
Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80. CrossRef
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;27:681–5. CrossRef
Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18. CrossRef
Passot G, Vaudoyer D, Cotte E, et al. Progression following neoadjuvant systemic chemotherapy may not be a contraindication to a curative approach for colorectal carcinomatosis. Ann Surg. 2012;256:125–9. CrossRef
Gelli M, Huguenin J, Cerebelli C, et al. Strategies to prevent peritoneal carcinomatosis arising from colorectal cancer. Future Med. 2017;13:907–18.
Serrano Del Moral Á, Pérez Viejo E, Manzanedo Romero I, et al. Cirugía de second look más HIPEC en pacientes sin evidencia de recidiva con alto riesgo de desarrollar carcinomatosis tras resección de cáncer colorrectal. Cir Esp. 2018;96(2):97–102. CrossRef
Baratti D, Kusamura S, Iusco D, et al. Hyperthermic intraperitoneal Chemotherapy (HIPEC) at the time of primary curative surgery in patients with colorectal cancer at high risk for metachronous peritoneal metastases. Ann Surg Oncol. 2017;24(1):167–75. CrossRef
Elias D, Honoré C, Dumont F, et al. Results of systematic second look surgery plus HIPEC in asymptomatic patients presenting a high risk of developing colorectal peritoneal carcinomatosis. Ann Surg. 2011;254:289–93. CrossRef
Honoré C, Goéré D, Souadka A, et al. Definition of patients presenting a high risk of developing peritoneal carcinomatosis after curative surgery for colorectal cancer: a systematic review. Ann Surg Oncol. 2013;20:183–92. CrossRef
Klaver CE, et al. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial. BMC Cancer. 2015;15:428–37. CrossRef
Hompes D, Tiek J, Wolthuis A. HIPEC in T4a colon cancer: a defendable treatment to improve the oncologic outcome? Ann Oncol. 2012;23:3123–9. CrossRef
Folprecht G, Köhne C, Lutz M, et al. Systemic chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Cancer Treat Res. 2007;134:425–40. PubMed
Van Santvoort HC, Braam HJ, Spekreijse KR, et al. Peritoneal carcinomatosis in t4 colorectal cancer: occurrence and risk factors. Ann Surg Oncol. 2014;21(5):1686–91. CrossRef
Segelman J, Granath F, Holm T, et al. Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2012;99(5):699–705. CrossRef
Ripley RT, Davis JL, Kemp CD, et al. Prospective randomized trial evaluating mandatory second look surgery with HIPEC and CRS vs. standard of care in patients at high risk of developing colorectal peritoneal metastases. Trials. 2010;11:62. CrossRef
Goere D, Glehen O, Quenet F, et al. Results of a randomized phase 3 study evaluating the potential benefit of a second look surgery plus HIPEC in patients at high risk of developing colorrectal peritoneal disease. J Clin Oncol. 2018;36(15):3531. CrossRef
Quenet F, Elias D, Roca L, et al. A UNICANCER phase III trial of Hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorrectal peritoneal carcinomatosis (PC): PRODIGE 7 (NCT 00769405).
Arjona A, Barrios P, Boldo-Roda E, et al. HIPECT4: Multicentre randomized clinical trial to evaluate safety and efficacy of HIPEC with Mitomycin C used during surgery for the treatment of locally advanced colorectal carcinoma. BMC. 2018;18:183.
Proactive management of endoperitoneal spread in colonic cancer. PROMENADE trial (NCT 02974556).
Trial evaluating surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) in treating patients with a high risk of developing colorectal peritoneal carcinomatosis (NCT 02179489).
- Prophylactic HIPEC in pT4 Colon Tumors: Proactive Approach or Overtreatment?
MD Nerea Borda Arrizabalaga
PhD José María Enriquez Navascués
MD Garazi Elorza Echaniz
PhD Yolanda Saralegui Ansorena
PhD Carlos Placer Galán
PhD Xabier Arteaga Martín
MD Leyre Velaz Pardo
- Springer International Publishing
Annals of Surgical Oncology
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
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