The online version of this article (doi:10.1186/1477-7819-10-56) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
EIB: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript. JLB: study conception and design, critical revision. AR: acquisition of data, analysis and interpretation of data, critical revision. DB: study conception and design, critical revision. JMB: analysis and interpretation of data, critical revision. The final version of this paper has been seen and approved by all authors.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment for patients with peritoneal carcinomatosis (PC). Our objective was to identify new prognostic factors in patients with PC from colorectal cancer treated with this procedure.
All patients with PC from colorectal cancer treated by HIPEC from January 2000 to December 2007 were prospectively included. The tumor extension was assessed by the Peritoneal Cancer Index (PCI) and the residual disease was recorded using the completeness cytoreductive score (CCs). All clinical and treatment data were computed in univariate and multivariable analyses using survival as primary end point.
We carried out 51 complete procedures in 49 consecutive patients. The mean PCI was 10. The allocation of CCs was: CC-0 = 37, CC-1 = 14. The five-year overall and progression-free survival rate were 40% and 20%, respectively. Several prognostic factors for survival were identified by univariate analysis: PCI < 9 (P < 0.001), CC-0 vs. CC-1 (P < 0.01) and involvement of area 4 (P = 0.06), area 5 (P = 0.031), area 7 (P = 0.014), area 8 (P = 0.022), area 10 (P < 0.0001), and area 11 (P = 0.02). Only the involvement of the distal jejunum (area 10) was significant in the multivariable analysis (P = 0.027).
We demonstrated that the involvement of area 10 (distal jejunum of the PCI score) was an independent factor associated with poor prognosis.
Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN: Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000, 88: 358-363. 10.1002/(SICI)1097-0142(20000115)88:2<358::AID-CNCR16>3.0.CO;2-O. CrossRefPubMed
Sugarbaker PH, Gianola FJ, Speyer JC, Wesley R, Barofsky I, Meyers CE: Prospective, randomized trial of intravenous versus intraperitoneal 5-fluorouracil in patients with advanced primary colon or rectal cancer. Surgery. 1985, 98: 414-422. PubMed
Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, Barone R, Yonemura Y, Cavaliere F, Quenet F, Gutman M, Tentes AA, Lorimier G, Bernard JL, Bereder JM, Porcheron J, Gomez-Portilla A, Shen P, Deraco M, Rat P: 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: 3284-3292. 10.1200/JCO.2004.10.012. CrossRefPubMed
Shen P, Hawksworth J, Lovato J, Loggie BW, Geisinger KR, Fleming RA, Levine EA: Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol. 2004, 11: 178-186. 10.1245/ASO.2004.05.009. CrossRefPubMed
Elias D, Lefevre JH, Chevalier J, Brouquet A, Marchal F, Classe JM, Ferron G, Guilloit JM, Meeus P, Goéré D, Bonastre J: Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009, 27: 681-685. 10.1200/JCO.2008.19.7160. CrossRefPubMed
Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA: Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003, 21: 3737-3743. 10.1200/JCO.2003.04.187. CrossRefPubMed
Sugarbaker PH, Averbach AM, Jacquet P, Stuart OA, Stephens AD: Hyperthermic intraoperative intreperitoneal chemotherapy (HIIC) with mitomycin C. Surg Technol Int. 1996, 5: 245-249. PubMed
Elias D, Antoun S, Goharin A, Otmany AE, Puizillout JM, Lasser P: Research on the best chemohyperthermia technique of treatment of peritoneal carcinomatosis after complete resection. Int J Surg Investig. 2000, 1: 431-439. PubMed
Beaujard AC, Glehen O, Caillot JL, Francois Y, Bienvenu J, Panteix G, Garbit F, Grandclément E, Vignal J, Gilly FN: Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis. Cancer. 2000, 88: 2512-2519. 10.1002/1097-0142(20000601)88:11<2512::AID-CNCR12>3.0.CO;2-J. CrossRefPubMed
Verwaal VJ, Boot H, Aleman BM, van Tinteren H, Zoetmulder FA: Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome. Ann Surg Oncol. 2004, 11: 375-379. 10.1245/ASO.2004.08.014. CrossRefPubMed
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: 829-835. PubMed
Elias D, Blot F, El Otmany A, Antoun S, Lasser P, Boige V, Rougier P, Ducreux M: Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer. 2001, 92: 71-76. 10.1002/1097-0142(20010701)92:1<71::AID-CNCR1293>3.0.CO;2-9. CrossRefPubMed
Esquivel J, Chua TC, Stojadinovic A, Melero JT, Levine EA, Gutman N, Howard R, Piso P, Nissan A, Gomez-Portilla A, Gonzalez-Bavon L, Gonzalez-Moreno S, Shen P, Stewart JH, Sugarbaker PH, Barone RM, Hoefer R, Morris DL, Sardi A, Sticca RP: Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J Surg Oncol. 2010, 102: 565-570. 10.1002/jso.21601. CrossRefPubMed
Berndt WO, Gosselon RE: Differential changes in permeability of mesentery to rubidium and phosphate. Am J Physiol. 1962, 202: 761-767. PubMed
Glehen O, Gilly FN, Boutitie F, Bereder JM, Quenet F, Sideris L, Mansvelt B, Lorimier G, Msika S, Elias D, French Surgical Association: Toward curative treatment of peritoneal carcinomatosis from non ovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010, 116: 5608-5618. 10.1002/cncr.25356. CrossRefPubMed
- Small bowel involvement is a prognostic factor in colorectal carcinomatosis treated with complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy
Emmanuel I Benizri
- BioMed Central
Neu im Fachgebiet Chirurgie
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