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Annals of Surgery:
doi: 10.1097/SLA.0b013e31827e9289
Original Articles

Is There a Possibility of a Cure in Patients With Colorectal Peritoneal Carcinomatosis Amenable to Complete Cytoreductive Surgery and Intraperitoneal Chemotherapy?

Goéré, Diane MD*; Malka, David MD, PhD; Tzanis, Dimitri MD*; Gava, Vinicius MD*; Boige, Valérie MD, PhD; Eveno, Clarisse MD*; Maggiori, Léon MD*; Dumont, Frédéric MD*; Ducreux, Michel MD, PhD; Elias, Dominique MD, PhD*

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Abstract

Background: Although a randomized trial demonstrated a survival benefit of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) over systemic chemotherapy alone, the treatment of peritoneal carcinomatosis from colorectal cancer (CRPC) is still a matter of debate. The aims of this study were to evaluate long-term outcome after CRS and IPC and to identify the prognostic factors associated with a cure.

Methods: Patients were considered cured if the disease-free survival interval lasted at least 5 years after the treatment of CRPC or its last recurrence. Patients who had died postoperatively, or from non–cancer-related deaths, or patients with a follow-up of less than 5 years since the last curative treatment were excluded from the analysis.

Results: From 1995 to 2006, 107 patients (median age, 48 years; range, 19–67 years) underwent complete CRS, followed by IPC. Postoperative complications occurred in 50 patients (53%), including 4 postoperative deaths. After a median follow-up of 77 months (range, 60–144 months), 5-year and 10-year overall survival rates were 35% and 15%, respectively. Seventeen patients (16%) were considered cured after a disease-free interval of at least 5 years, of whom 14 never developed a recurrence. Cured patients had a significantly lower median peritoneal cancer index than noncured patients, respectively 4 (3–16) and 12 (2–36) (P = 0.0002). In multivariate analysis, a peritoneal cancer index of 10 or less was the only independent factor predicting cure.

Conclusions: The cure rate (16%) after complete CRS of colorectal peritoneal carcinomatosis, followed by IPC, in selected patients is close to that obtained after resection of colorectal liver metastases.

© 2013 Lippincott Williams & Wilkins, Inc.

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