Simultaneous Parenchyma-Preserving Liver Resection, Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stage IV Colorectal Cancer

• Published in: Acta chirurgica belgica 2015-07, Vol.115 (4), p.261-267
• Main Authors: Abreu de Carvalho, L.F., Scuderi, V., Maes, H., Cupo, P., Geerts, B., Van Bockstal, M., Gremonprez, F., Willaert, W., Pattyn, P., Troisi·, R., Ceelen, W.
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2015.11681109

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). Conclusion: 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.