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Prior Surgical Score: An Analysis of the Prognostic Significance of an Initial Nondefinitive Surgical Intervention in Patients With Peritoneal Carcinomatosis of a Colorectal Origin Undergoing Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy

Paul, Bikram, K., M.D., M.S.1,2; Ihemelandu, Chukwuemeka, M.D.1; Sugarbaker, Paul, H., M.D., F.R.C.S. (Hon.)1

Diseases of the Colon & Rectum: March 2018 - Volume 61 - Issue 3 - p 347–354
doi: 10.1097/DCR.0000000000001003
Original Contributions: Colorectal Cancer
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BACKGROUND: The prior surgical score estimates the extent of previous surgical intervention by quantitating surgical dissection within 9 abdominopelvic regions.

OBJECTIVE: Our aim was to analyze the prognostic significance of the prior surgical score in our cohort of patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of a colorectal origin.

DESIGN: This was a retrospective analysis of a prospectively maintained database for all patients treated for peritoneal carcinomatosis of a colorectal origin.

SETTINGS: The prospectively maintained surgical oncology tumor database was analyzed for the study period 1989–2014.

PATIENTS: A total of 407 patients diagnosed with peritoneal carcinomatosis of a colorectal origin and treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy were included in this analysis.

MAIN OUTCOME MEASURES: The prognostic significance and clinicopathologic factors associated with an initial nondefinitive surgical intervention in patients with peritoneal carcinomatosis of a colorectal origin undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy was evaluated.

RESULTS: There were 210 men (51.6%) and 197 women (48.4%) in the study. Mean age at presentation was 53.7 years (range, 19.0–87.0 y). Data on prior surgical score for 69 patients were missing, leaving us with a study cohort of 338 patients. Grouped by prior surgical score, 46 (13.6%) had a prior surgical score of 0 versus 25 (7.4%), 122 (36.1%), and 145 (42.9%) who had a prior surgical score of 1, 2, or 3. Overall survival was 53.0%. Three- and 5-year survival rates were 75% and 75% for group prior surgical score 0 versus 26% and 13%, 39% and 37%, and 21% and 16% for group prior surgical scores 1, 2, and 3. Median survival time for the various prior surgical score groups were 180.0, 30.4, 30.5, and 21.3 months for prior surgical scores 0, 1, 2, and 3 (p = 0.000). A total of 87.2% of the prior surgical score 0 group had a completeness of cytoreduction score of 0/1 (no residual disease/tumor <0.25 cm) versus 68.0%, 68.1%, and 48.6% for prior surgical scores of 1, 2, or 3 (p = 0.000). Significant independent predictors of a shorter survival in multivariate analysis included a high cytoreduction score status (p < 0.000) and a high prior surgical score (p = 0.05).

LIMITATIONS: This study was limited by its retrospective, population-based design.

CONCLUSIONS: The extent of a previous nondefinitive surgical intervention contributes to the poor prognosis associated with peritoneal carcinomatosis of a colorectal origin. Independent predictors for an improved overall survival include completeness of cytoreduction and low prior surgical score. See Video Abstract at http://links.lww.com/DCR/A573.

1 Program in Peritoneal Surface Oncology, Washington Cancer Institute, Medstar Washington Hospital Center, Washington, DC

2 Program in Colorectal Surgery, Washington Cancer Institute, Medstar Washington Hospital Center, Washington, DC

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Bikram K. Paul, M.D., M.S., Medstar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010. E-mail: bikramkpaul@gmail.com

© 2018 The American Society of Colon and Rectal Surgeons