Secondary cytoreductive surgery and peri-operative intraperitoneal chemotherapy for peritoneal recurrence of colorectal and appendiceal peritoneal carcinomatosis following prior primary cytoreduction

• Published in: Journal of surgical oncology 2013-05, Vol.107 (6), p.585-590
• Main Authors: Klaver, Yvonne L.B., Chua, Terence C., Verwaal, Victor J., de Hingh, Ignace H.J.T., Morris, David L.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adult; Antineoplastic Agents - therapeutic use; Appendiceal Neoplasms - pathology; Chemotherapy, Adjuvant; Chemotherapy, Cancer, Regional Perfusion - methods; colorectal cancer; Colorectal Neoplasms - pathology; cytoreductive surgery; Female; Fluorouracil - therapeutic use; Follow-Up Studies; Humans; Hyperthermia, Induced; Infusions, Parenteral; Kaplan-Meier Estimate; Male; metastasis; Middle Aged; Mitomycin - therapeutic use; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - secondary; Neoplasm Recurrence, Local - therapy; Organoplatinum Compounds - therapeutic use; peritoneal carcinomatosis; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Peritoneum - surgery; Prospective Studies; Survival Rate; Treatment Outcome
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.23303

Purpose Primary cytoreductive surgery (CRS) and peri‐operative intraperitoneal chemotherapy (PIC) is the only curative option for patients with colorectal cancer peritoneal carcinomatosis (PC). A significant proportion of patients develop peritoneal recurrence. Outcomes of patients undergoing secondary CRS and PIC for recurrent PC were examined. Methods All patients undergoing second procedures with curative intent for recurrent appendiceal or colorectal cancer PC in three centers were included. Patients with recurrent pseudomyxoma peritonei (PMP) were excluded. Morbidity and mortality, overall survival, and disease‐free survival were primary outcome parameters. Results The study included 18 patients (13 colorectal and 5 appendiceal cancer). At primary CRS, mean Peritoneal Cancer Index (PCI) was 9.1. In 13 patients complete resection was achieved. Median time to recurrence was 14 months (range: 1–33). At secondary CRS, mean PCI was 6.3 and CRS was complete in 13 patients. There was no 30‐day mortality and 1‐ and 2‐year survival were 74% and 50%, respectively. In 14 patients a recurrence after the second procedure was diagnosed. Conclusions A secondary CRS for recurrent colorectal or appendiceal cancer PC is safe and feasible, however, relapse is frequent. Further investigations are required to critically assess the efficacy of a secondary procedure and to define optimal patient selection criteria in the era of effective modern chemotherapy. J. Surg. Oncol. 2013;107:585–590. © 2012 Wiley Periodicals, Inc.