Article: Simultaneous Parenchyma-Preserving Liver Resection, Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stage IV Colorectal Cancer.
2015 Volume 115, Issue 4, Page(s) 261–267
Abstract: Background: The outcome of stage IV colorectal cancer (CRC) has improved with modern systemic therapy. However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis and surgery ... ...
| Abstract | Background: The outcome of stage IV colorectal cancer (CRC) has improved with modern systemic therapy. However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis and surgery in this context remains exceptional. Methods: Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from prospectively collected databases. We assessed response to neoadjuvant chemotherapy (NACT), postoperative complications, progression free survival (PFS), and overall survival (OS). Results: Twenty-one patients with resectable disease were treated between 2007 and 2014. In 16 patients (76%), NACT was administered and tumour response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence. Median peritoneal cancer index was 5 (range: 3-10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 45 hepatic lesions with a median of 2 per patient (range: 1-2) and a median size of 1.35 cm (range: 0.8-2). Tumour regression grade 4 (fibrosis but residual cancer cells predominate) was seen in 50% of the resected metastases after NACT. Median hospital stay was 17 days (range: 14-24); severe morbidity (Clavien-Dindo grade 3-4) occurred in 24% and no perioperative mortality (0-90 days) was recorded. The median OS was 44 months (range: 31-57) while the median PFS was 10 months (range: 8-12). Conclusions: Combined parenchyma-preserving liver resection, cytoreductive surgery and IPC in patients with LM and PC from CRC can be performed safely and results in promising mid-term overall survival. |
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| MeSH term(s) | Ablation Techniques ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemotherapy, Cancer, Regional Perfusion ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Female ; Hepatectomy/methods ; Humans ; Hyperthermia, Induced ; Length of Stay/statistics & numerical data ; Liver Neoplasms/secondary ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Peritoneal Neoplasms/secondary ; Peritoneal Neoplasms/therapy ; Postoperative Complications |
| Language | English |
| Publishing date | 2015-07-23 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 210274-2 |
| ISSN | 0001-5458 |
| ISSN | 0001-5458 |
| DOI | 10.1080/00015458.2015.11681109 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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