TY - JOUR
T1 - Impact of Synchronous Versus Metachronous Onset of Colorectal Peritoneal Metastases on Survival Outcomes After Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
T2 - A Multicenter, Retrospective, Observational Study
AU - Hentzen, Judith E. K. R.
AU - Rovers, Koen P.
AU - Kuipers, Hendrien
AU - van der Plas, Willemijn Y.
AU - Been, Lukas B.
AU - Hoogwater, Frederik J. H.
AU - van Ginkel, Robert J.
AU - Hemmer, Patrick H. J.
AU - van Dam, Gooitzen M.
AU - de Hingh, Ignace H. J. T.
AU - Kruijff, Schelto
PY - 2019/7
Y1 - 2019/7
N2 - Background. Careful selection of patients with colorectal peritoneal metastases (PM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. It remains unknown whether the time of onset of colorectal PM (synchronous vs metachronous) influences surgical morbidity and survival outcomes after CRS with HIPEC.Methods. Patients with histologically proven colorectal PM who underwent CRS with HIPEC between February 2006 and December 2017 in two Dutch tertiary referral hospitals were retrospectively included from a prospectively maintained database. The onset of colorectal PM was classified as synchronous (PM diagnosed at the initiationalpresentation with colorectal cancer) or metachronous (PM diagnosed after initial curative colorectal resection). Major postoperative complications (Clavien-Dindo grade >= 3), overall survival (OS), and disease-free survival (DFS) were compared between patients with synchronous colorectal PM and those with metachronous colorectal PM using Kaplan-Meier analyses, proportional hazard analyses, and a multivariate Cox regression analysis.Results. The study enrolled 433 patients, of whom 231 (53%) had synchronous colorectal PM and 202 (47%) had metachronous colorectal PM. The major postoperative complication rate and median OS were similar between the patients with synchronous colorectal PM and those with metachronous colorectal PM (26.8% vs 29.7%; p=0.693 and 34 vs 33months, respectively; p=0.819). The median DFS was significantly decreased for the patients with metachronous colorectal PM and those with synchronous colorectal PM (11 vs 15months; adjusted hazard ratio, 1.63; 95% confidence interval, 1.18-2.26).Conclusions. Metachronous onset of colorectal PM is associated with early recurrence after CRS with HIPEC compared with synchronous colorectal PM, without a difference in OS or major postoperative complications. Time to onset of colorectal PM should be taken into consideration to optimize patient selection for this major procedure.
AB - Background. Careful selection of patients with colorectal peritoneal metastases (PM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. It remains unknown whether the time of onset of colorectal PM (synchronous vs metachronous) influences surgical morbidity and survival outcomes after CRS with HIPEC.Methods. Patients with histologically proven colorectal PM who underwent CRS with HIPEC between February 2006 and December 2017 in two Dutch tertiary referral hospitals were retrospectively included from a prospectively maintained database. The onset of colorectal PM was classified as synchronous (PM diagnosed at the initiationalpresentation with colorectal cancer) or metachronous (PM diagnosed after initial curative colorectal resection). Major postoperative complications (Clavien-Dindo grade >= 3), overall survival (OS), and disease-free survival (DFS) were compared between patients with synchronous colorectal PM and those with metachronous colorectal PM using Kaplan-Meier analyses, proportional hazard analyses, and a multivariate Cox regression analysis.Results. The study enrolled 433 patients, of whom 231 (53%) had synchronous colorectal PM and 202 (47%) had metachronous colorectal PM. The major postoperative complication rate and median OS were similar between the patients with synchronous colorectal PM and those with metachronous colorectal PM (26.8% vs 29.7%; p=0.693 and 34 vs 33months, respectively; p=0.819). The median DFS was significantly decreased for the patients with metachronous colorectal PM and those with synchronous colorectal PM (11 vs 15months; adjusted hazard ratio, 1.63; 95% confidence interval, 1.18-2.26).Conclusions. Metachronous onset of colorectal PM is associated with early recurrence after CRS with HIPEC compared with synchronous colorectal PM, without a difference in OS or major postoperative complications. Time to onset of colorectal PM should be taken into consideration to optimize patient selection for this major procedure.
KW - QUALITY-OF-LIFE
KW - POSTOPERATIVE COMPLICATIONS
KW - SYSTEMIC CHEMOTHERAPY
KW - EARLY RECURRENCE
KW - RISK-FACTORS
KW - CARCINOMATOSIS
KW - CANCER
KW - ORIGIN
KW - CLASSIFICATION
KW - MORBIDITY
U2 - 10.1245/s10434-019-07294-y
DO - 10.1245/s10434-019-07294-y
M3 - Article
SN - 1068-9265
VL - 26
SP - 2210
EP - 2221
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 7
ER -