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Clinical benefit of surgery for stage IV colorectal cancer with synchronous peritoneal metastasis
Authors:Hirotoshi Kobayashi  Kenjiro Kotake  Kimihiko Funahashi  Kazuo Hase  Koichi Hirata  Tsuneo Iiai  Shingo Kameoka  Yukihide Kanemitsu  Koutarou Maeda  Akihiko Murata  Masayuki Ohue  Kazuo Shirouzu  Keiichi Takahashi  Toshiaki Watanabe  Hideaki Yano  Toshimasa Yatsuoka  Yojiro Hashiguchi  Kenichi Sugihara
Affiliation:1. Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
2. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
3. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan
4. Department of Surgery, Toho University, Tokyo, Japan
5. Department of Surgery, National Defense Medical College, Tokorozawa, Japan
6. First Department of Surgery, Sapporo Medical University, Sapporo, Japan
7. Department of Surgery, Niigata University, Niigata, Japan
8. Second Department of Surgery, Tokyo Women’s Medical University, Tokyo, Japan
9. Department of Surgery, Aichi Cancer Center, Nagoya, Japan
10. Department of Surgery, Fujita Health University, Toyoake, Japan
11. Department of Surgery, Hirosaki University, Hirosaki, Japan
12. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
13. Department of Surgery, Kurume University, Kurume, Japan
14. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
15. Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
16. Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
17. Department of Surgery, Saitama Cancer Center, Saitama, Japan
18. Department of Surgery, Teikyo University, Tokyo, Japan
Abstract:

Background

Peritoneal metastasis is well-known as a poor prognostic factor in patients with colorectal cancer. It is important to improve the prognosis of patients with colorectal cancer and synchronous peritoneal metastasis. This study aimed to clarify the factors affecting R0 resection and the prognosis of colorectal cancer patients with synchronous peritoneal metastasis.

Methods

We investigated the data of patients with stage IV colorectal cancer between 1991 and 2007 in 16 hospitals that were members of the Japanese Society for Cancer of the Colon and Rectum.

Results

Of the 564 colorectal cancer patients with synchronous peritoneal metastases, 341 also had hematogenous metastases. The 5-year overall survival rates in patients with and without R0 resection were 32.4 and 4.7 %, respectively. A Cox proportional hazards model showed that histologic type of poorly differentiated adenocarcinoma, regional lymph node metastasis, liver metastasis, chemotherapy after surgery, R0 resection, the Japanese classification of peritoneal metastasis, and the size of peritoneal metastases were independent prognostic factors. Of the 564 patients, 28.4 % had R0 resection. The Japanese classification of peritoneal metastasis (P1–P2, p = 0.0024) and absence of hematogenous metastases (p < 0.0001) were associated with R0 resection.

Conclusions

P1–P2 peritoneal metastasis and the absence of hematogenous metastasis were the most favorable factors benefiting from synchronous resection of peritoneal metastasis. In addition, chemotherapy after surgery was essential.
Keywords:
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