KEY TAKEAWAYS
- The study aimed to investigate the safety and OS benefits of CRS/HIPEC in patients with CRC with extremely high PCI >20.
- Researchers noticed that carefully selected patients with CRC achieved comparable perioperative safety and OS outcomes with CRS/HIPEC.
Colorectal peritoneal metastases are a devastating consequence of colorectal cancer (CRC) with extremely poor prognosis. Patients who can undergo complete cytoreduction by cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) have markedly improved overall survival (OS). Traditionally, patients with extremely high peritoneal cancer index (PCI), PCI >20, are not offered CRS/HIPEC.
Almog Ben-Yaacov and the team aimed to assess the safety and OS benefits of CRS/HIPEC in patients with CRC and extremely high PCI.
They conducted an inclusive analysis utilizing a retrospective review of a prospectively maintained CRS/HIPEC database, assessing patients with CRC peritoneal metastases from 2012 to 2022. Cohorts were stratified based on operative PCI, distinguishing between low PCI (<20) and high PCI (≥20). Demographic, clinicopathologic, perioperative, and oncological outcomes were meticulously examined across the cohorts.
They analyzed 691 patients who underwent CRS/HIPEC, identifying 289 with CRC metastases, comprising 234 with PCI <20 and 43 with PCI ≥20. Median preoperative and operative PCI were 4 and 10 in the low PCI group, contrasting with 7 and 24.5 in the high PCI group. The high PCI cohort experienced longer operative times (6 vs. 4 hours) and increased blood loss (500 vs. 400 mL).
However, all other demographic, clinicopathological, and operative characteristics remained similar between the cohorts. Median disease-free survival (DFS) favored the low PCI cohort (11.5 vs. 7 months), while OS demonstrated benefit for the low PCI group (41.3 vs. 31.8 months). These differences in survival outcomes were statistically significant for DFS (P = 0.001) but not for OS (P = 0.189) when compared to a chemotherapy-only strategy.
The study concluded that carefully selected patients with CRC metastases and extremely high PCI exhibit comparable perioperative safety outcomes in experienced tertiary referral centers. Despite a shorter median DFS, these patients demonstrated similar median OS.
The study received no funds.
Source: https://pubmed.ncbi.nlm.nih.gov/38686748/
Ben-Yaacov A, Levine O, Schtrechman G, et al. (2024). “Extremely high peritoneal cancer index in colorectal peritoneal metastases demonstrates safety and overall survival benefit in selected patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy.” World J Surg. 2024 Apr;48(4):871-878. doi: 10.1002/wjs.12080. Epub 2024 Jan 9. PMID: 38686748.
