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Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases

Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases
Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases
AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).

METHODS: An electronic literature search was carried out to identify publications reporting oncological outcome data (overall survival and/or disease free survival and/or recurrence rates) following CRS and IPC for treatment of CPM. Studies reporting outcomes following CRS and IPC for cancer subtypes other than colorectal were only included if data were reported independently for colorectal cancer-associated cases; in addition studies reporting outcomes for peritoneal carcinomatosis of appendiceal origin were excluded.

RESULTS: Twenty seven studies, published between 1999 and 2013 with a combined population of 2838 patients met the predefined inclusion criteria. Included studies comprised 21 case series, 5 case-control studies and 1 randomised controlled trial. Four studies provided comparative oncological outcome data for patients undergoing CRS in combination with IPC vs systemic chemotherapy alone. The primary indication for treatment was CPM in 96% of cases (2714/2838) and recurrent CPM (rCPM) in the remaining 4% (124/2838). In the majority of included studies (20/27) CRS was combined with hyperthermic intraperitoneal chemotherapy (HIPEC). In 3 studies HIPEC was used in combination with early post-operative intraperitoneal chemotherapy (EPIC), and 2 studies used EPIC only, following CRS. Two studies evaluated comparative outcomes with CRS + HIPEC vs CRS + EPIC for treatment of CPM. The delivery of IPC was performed using an “open” or “closed” abdomen approach in the included studies.

CONCLUSION: The available evidence presented in this review indicates that enhanced survival times can be achieved for CPM after combined treatment with CRS and IPC.

Core tip: Colorectal cancer peritoneal metastases (CPM) confer a dismal prognosis and traditional treatment involving systemic chemotherapy, with or without palliative surgery has poor outcomes. Cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IPC) is now advocated for selected patients with CPM. The present study provides a comprehensive summary of the available evidence relating to CRS in combination with IPC in the setting of CPM, focusing on techniques, oncological outcomes, and complications.
colorectal cancer, peritoneal metastasis, cytoreductive surgery, intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy
1007-9327
14018-14032
Mirnezami, Reza
d0d4ded7-1d72-4ce4-9ce1-eac5ded0232f
Moran, Brendan J.
3465969e-87a1-4ddd-ad74-b0d1ef160f41
Harvey, Kate
93c6819e-7c23-4bfd-981f-c65d249d7692
Cecil, Tom
fff8d82e-2019-402f-a931-1c9591ffc133
Chandrakumaran, Kandiah
f26f4bda-dfcd-439c-b449-3184b7ec7ddb
Carr, Norman
810e44dc-90d5-496c-85b6-6b2fa1c07dd7
Mohamed, Faheez
11e760f5-fd56-4f32-9264-22a2e710b365
Mirnezami, Alexander H.
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Mirnezami, Reza
d0d4ded7-1d72-4ce4-9ce1-eac5ded0232f
Moran, Brendan J.
3465969e-87a1-4ddd-ad74-b0d1ef160f41
Harvey, Kate
93c6819e-7c23-4bfd-981f-c65d249d7692
Cecil, Tom
fff8d82e-2019-402f-a931-1c9591ffc133
Chandrakumaran, Kandiah
f26f4bda-dfcd-439c-b449-3184b7ec7ddb
Carr, Norman
810e44dc-90d5-496c-85b6-6b2fa1c07dd7
Mohamed, Faheez
11e760f5-fd56-4f32-9264-22a2e710b365
Mirnezami, Alexander H.
b3c7aee7-46a4-404c-bfe3-f72388e0bc94

Mirnezami, Reza, Moran, Brendan J., Harvey, Kate, Cecil, Tom, Chandrakumaran, Kandiah, Carr, Norman, Mohamed, Faheez and Mirnezami, Alexander H. (2014) Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases. World Journal of Gastroenterology, 20 (38), 14018-14032. (doi:10.3748/wjg.v20.i38.14018). (PMID:25320542)

Record type: Article

Abstract

AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).

METHODS: An electronic literature search was carried out to identify publications reporting oncological outcome data (overall survival and/or disease free survival and/or recurrence rates) following CRS and IPC for treatment of CPM. Studies reporting outcomes following CRS and IPC for cancer subtypes other than colorectal were only included if data were reported independently for colorectal cancer-associated cases; in addition studies reporting outcomes for peritoneal carcinomatosis of appendiceal origin were excluded.

RESULTS: Twenty seven studies, published between 1999 and 2013 with a combined population of 2838 patients met the predefined inclusion criteria. Included studies comprised 21 case series, 5 case-control studies and 1 randomised controlled trial. Four studies provided comparative oncological outcome data for patients undergoing CRS in combination with IPC vs systemic chemotherapy alone. The primary indication for treatment was CPM in 96% of cases (2714/2838) and recurrent CPM (rCPM) in the remaining 4% (124/2838). In the majority of included studies (20/27) CRS was combined with hyperthermic intraperitoneal chemotherapy (HIPEC). In 3 studies HIPEC was used in combination with early post-operative intraperitoneal chemotherapy (EPIC), and 2 studies used EPIC only, following CRS. Two studies evaluated comparative outcomes with CRS + HIPEC vs CRS + EPIC for treatment of CPM. The delivery of IPC was performed using an “open” or “closed” abdomen approach in the included studies.

CONCLUSION: The available evidence presented in this review indicates that enhanced survival times can be achieved for CPM after combined treatment with CRS and IPC.

Core tip: Colorectal cancer peritoneal metastases (CPM) confer a dismal prognosis and traditional treatment involving systemic chemotherapy, with or without palliative surgery has poor outcomes. Cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IPC) is now advocated for selected patients with CPM. The present study provides a comprehensive summary of the available evidence relating to CRS in combination with IPC in the setting of CPM, focusing on techniques, oncological outcomes, and complications.

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More information

Accepted/In Press date: 26 June 2014
Published date: 14 October 2014
Additional Information: The available evidence presented in this review indicates that enhanced survival times can be achieved for CPM after combined treatment with CRS and IPC.
Keywords: colorectal cancer, peritoneal metastasis, cytoreductive surgery, intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy
Organisations: Cancer Sciences

Identifiers

Local EPrints ID: 373971
URI: http://eprints.soton.ac.uk/id/eprint/373971
ISSN: 1007-9327
PURE UUID: c9ebdc15-02ea-4914-be97-29e30885f1fb

Catalogue record

Date deposited: 04 Feb 2015 12:01
Last modified: 14 Mar 2024 19:00

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Contributors

Author: Reza Mirnezami
Author: Brendan J. Moran
Author: Kate Harvey
Author: Tom Cecil
Author: Kandiah Chandrakumaran
Author: Norman Carr
Author: Faheez Mohamed

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