Outcomes following synchronous liver resection,cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases: A bi-institutional study |
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| Affiliation: | 1. University of New South Wales, Department of Surgery, St George Hospital, Kogarah, Australia;2. Colorectal & Surgical Oncology, KKUH, King Saud University, Riyadh, Saudi Arabia;3. Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia;4. Department of Interventional Radiology, St George Hospital, Kogarah, Australia;5. Cancer Care Center, St George Hospital, Kogarah, Australia;1. Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California;2. Department of Surgery, University of Chicago Medical Center, Chicago, Illinois;3. Department of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center, Duarte, California;1. Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, the Netherlands;2. Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, the Netherlands;3. Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University Medical Center Groningen, University of Groningen, the Netherlands;1. Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA;1. Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands;2. Department of Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands;3. Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands;4. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands;5. Department of Pathology, Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute, Amsterdam, Netherlands;6. Department of Surgery, Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute, Amsterdam, Netherlands;7. Department of Surgery, Erasmus Medical centre at Daniel den Hoed, Rotterdam, Netherlands;8. Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands;9. Department of Surgery, Catharina Hospital, Eindhoven, Netherlands;10. Department of Surgery, Bravis Hospital, Roosendaal, Netherlands;11. Department of Surgery, Maasziekenhuis Pantein, Beugen, Netherlands;12. Department of Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands;13. Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands;14. Department of Surgery, Universitair Medical Centre Groningen, Groningen, Netherlands;15. Department of Surgery, Bernhoven, Uden, Netherlands;p. Department of Surgery, Amsterdam UMC, Free University, Cancer Centre Amsterdam, Amsterdam, Netherlands;q. Department of Surgery, Flevo hospital, Almere, Netherlands;r. Department of Surgery, Isala Hospital, Zwolle, Netherlands;s. Department of Surgery, St Antonius Hospital, CM Nieuwegein, Netherlands;t. Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands;u. Department of Internal Medicine, Amstelland Hospital, Amstelveen, Netherlands |
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| Abstract: | PurposeSynchronous liver resection, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal liver (CRLM) and peritoneal metastases (CRPM) has traditionally been contraindicated. However, latest practice promotes specialist, multidisciplinary-led consideration for select patients. This study aimed to evaluate the perioperative and oncological outcomes of synchronous resection in the management of CRLM and CRPM from two tertiary referral centres.MethodThis bi-institutional, retrospective, cohort study included patients undergoing simultaneous liver resection, CRS and HIPEC for metastatic colorectal cancer from 2013 to 2020. Patients treated with ablative liver techniques, staged operative approaches and extra abdominal disease were excluded. Overall survival (OS) and disease-free survival (DFS) rates were assessed. Univariate and multivariate analyses identified variables associated with survival and major morbidity (Clavien-Dindo grade III/IV).ResultsTwenty-three patients were included. The median peritoneal carcinomatosis index (PCI) was 9 (range 0–22). There were two major liver resections and 21 minor resections. CC-0 resections were achieved in all patients. Major morbidity occurred in 7 patients. There were no deaths at 90 days. PCI was independently associated with morbidity (p = 0.04). PCI >10 (p = 0.069), major morbidity (p = 0.083) and presence of KRAS mutation (p = 0.052) approached significance for poor OS. Median follow up was 21 months (4–54 months). Median OS was 37 months, 3-year survival 54%, and median DFS 18 months.ConclusionSynchronous liver resection, cytoreductive surgery and HIPEC is feasible in selected patients with low-volume CRPM and CRLM. Increasing PCI is associated with postoperative major morbidity, and should be considered during operative planning. |
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| Keywords: | Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy HIPEC Colorectal peritoneal metastases Colorectal liver metastases Liver resection |
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