Institutional members access full text with Ovid®

Share this article on:

Prognostic Significance of Peritoneal Metastasis in Stage IV Colorectal Cancer Patients With R0 Resection: A Multicenter, Retrospective Study

Arakawa, Keiichi M.D.1; Kawai, Kazushige M.D., Ph.D.1; Ishihara, Soichiro M.D., Ph.D.1; Hata, Keisuke M.D., Ph.D.1; Nozawa, Hiroaki M.D., Ph.D.1; Oba, Koji Ph.D.2; Sugihara, Kenichi M.D., Ph.D.3; Watanabe, Toshiaki M.D., Ph.D.1

doi: 10.1097/DCR.0000000000000858
Original Contributions: Colorectal/Anal Neoplasia
Denotes Associated Video Abstract
Denotes Twitter Account Access

BACKGROUND: Stage IV colorectal cancer encompasses various clinical conditions. The differences in prognosis after surgery between different metastatic organs have not been fully investigated.

OBJECTIVE: This study aimed to assess prognostic significance in peritoneal metastasis in R0 resected stage IV colorectal cancer.

DESIGN: We conducted a multicenter retrospective study of patients with R0 resected stage IV colorectal cancer; they were categorized into 3 groups according to the number and location of metastatic organs, including single-organ metastasis in the peritoneum, single-organ metastasis at sites except the peritoneum, and multiple-organ metastases.

SETTINGS: This study used data accumulated by the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer.

PATIENTS: A total of 1133 patients with R0 resected stage IV colorectal cancer were registered retrospectively between 1997 and 2007 in 20 referral hospitals.

MAIN OUTCOME MEASURES: Cancer-specific survival rates between the groups were measured.

RESULTS: The median cancer-specific survival of the single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group and was almost comparable to that of the multiple-organ metastases group (3.41 years, 6.20 years, and 2.99 years). In a multivariate analysis of cancer-specific survival, peritoneal dissemination was confirmed as an independent prognostic factor of survival. The median postrecurrence survival of single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group. Approximately half of the patients who experienced recurrence of single-organ metastasis in the peritoneum experienced peritoneal recurrence.

LIMITATIONS: This was a retrospective, population-based study that requires a prospective design to validate its conclusions.

CONCLUSIONS: Peritoneal metastasis of colorectal cancer frequently recurred in the peritoneum even after R0 resection. The cancer-specific survival of the single-organ metastasis in the peritoneum group was as poor as that of the multiple-organ metastases group. See Video Abstract at http://links.lww.com/DCR/A398.

Supplemental Digital Content is available in the text.

1 Department of Surgical Oncology, University of Tokyo Hospital, Tokyo, Japan

2 Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

3 Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Keiichi Arakawa, M.D., Department of Surgical Oncology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: Keiichiarakawa@hotmail.com

© 2017 The American Society of Colon and Rectal Surgeons