Increase in the incidence of synchronous and metachronous peritoneal metastases in patients with colorectal cancer: A nationwide study

R.J. Lurvink, C. Bakkers, A. Rijken, F.N. van Erning, S.W. Nienhuijs, J.W. Burger, G.J. Creemers, C. Verhoef, V.E. Lemmens, I.H. De Hingh*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction: - To investigate the incidence of, factors associated with, and differences between synchronous and metachronous colorectal peritoneal metastases (CPM) in a population-based cohort.Methods: - Data from the Netherlands Cancer Registry were used. All patients diagnosed with colorectal cancer (CRC) between 1 January and June 30, 2015 were evaluated for synchronous or metachronous CPM (diagnosis <90 or >90 days after surgery for primary CRC), and survival in 2019 (median follow-up 38.4 months).Results: - Of 7233 included patients, 409 (5.7%) were diagnosed with synchronous CPM. Factors associated with synchronous CPM were mucinous (OR 2.72 [1.90-3.90]) or signet ring cell (SRC) histology (OR 6.58 [3.66-11.81]), T4 (OR 4.82 [3.68-6.32]), N1 (OR 1.66 [1.20-2.30]), or N2 stage (OR 3.27 [2.36 -4.52]), and synchronous systemic metastases (SM) (OR 3.13 [2.37-4.14]). After surgery for primary CRC, 326 patients developed metachronous CPM after a median time of 14.7 months (3-year cumulative incidence: 5.5%). Factors associated with metachronous CPM were younger age (HR 1.63 [1.10-2.42]), mucinous (HR 1.84 [1.20-2.82]) or SRC histology (HR 2.43 [1.11-5.32]), T4 (HR 2.77 [2.07-3.70]), N1 (HR 2.90 [2.18-3.85]), N2 (HR 3.19 [2.26-4.50]), and synchronous SM (HR 1.95 [1.43-2.66]).Conclusion: - This population-based study found the highest incidence of CPM currently reported in literature and a strong association between the presence of synchronous SM and both synchronous and metachronous CPM. These findings may contribute to a tailored approach in the follow-up after primary CRC surgery and guide future clinical trials investigating new strategies regarding risk-reduction or early detection of metachronous CPM. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Original languageEnglish
Pages (from-to)1026-1033
Number of pages8
JournalEuropean Journal of Surgical Oncology
Issue number5
Publication statusPublished - 1 May 2021


  • Colorectal cancer
  • Incidence
  • Peritoneal metastases
  • RISK
  • Risk factors

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