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Surgical Treatment of Colorectal Cancer with Peritoneal and Liver Metastases Using Combined Liver and Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Report from a Single-Centre Experience

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chemotherapeutic advances have enabled successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) expansion in treating metastatic colorectal cancer.

Objectives

The aims of this study were to evaluate the safety of combining liver surgery (LS) with HIPEC and CRS (which remains controversial) and its impact on overall survival (OS) rates.

Methods

From 2007 to 2015, a total of 77 patients underwent CRS/HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer. Twenty-five of these patients underwent concomitant LS for suspicion of liver metastases (LM; group 2), and were compared with patients who underwent CRS/HIPEC only (group 1). Demographic and clinical data were reviewed retrospectively.

Results

Among the group 2 patients, two underwent major hepatectomies, six underwent multiple wedge resections, 16 underwent single wedge resections (one with radiofrequency ablation), and one underwent radiofrequency ablation alone. For groups 1 and 2, median peritoneal cancer index was 6 and 10 (range 0–26; p = 0.08), complication rates were 15.4 and 32.0 % (Dindo–Clavien ≥3; p = 0.15), and median follow-up was 34.2 and 25.5 months (range 0–75 and 3–97), respectively. One group 2 patient died of septic shock after 66 days. Pathology confirmed LM in 21 patients in group 2 (four with benign hepatic lesions were excluded from long-term outcome analysis). Two-year OS rates were 89.5 and 70.2 % (p = 0.04), and 2-year recurrence-free survival rates were 38.3 and 13.4 % (p = 0.01) in groups 1 and 2, respectively.

Conclusions

Simultaneous surgery for colorectal LM and PC is both feasible and safe, with low postoperative morbidity. Further longer-term studies would help determine its impact on patient survival.

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Acknowledgment

The authors are most grateful to Dr. Claire de Burbure-Craddock for revising the manuscript.

Conflicts of Interest

Julie Navez, Christophe Remue, Daniel Leonard, Radu Bachmann, Alex Kartheuser, Catherine Hubert, Laurent Coubeau, Mina Komuta, Marc Van den Eynde, Francis Zech, and Nicolas Jabbour declare no conflicts of interest.

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Authors and Affiliations

  1. Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Julie Navez MD, Catherine Hubert MD, PhD, Laurent Coubeau MD & Nicolas Jabbour MD, FACS

  2. Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Julie Navez MD, Christophe Remue MD, Daniel Leonard MD, PhD, Radu Bachmann MD & Alex Kartheuser MD, PhD

  3. Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Mina Komuta MD, PhD

  4. Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Marc Van den Eynde MD

  5. Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Francis Zech MD, PhD

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  1. Julie Navez MD
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Correspondence to Nicolas Jabbour MD, FACS.

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Navez, J., Remue, C., Leonard, D. et al. Surgical Treatment of Colorectal Cancer with Peritoneal and Liver Metastases Using Combined Liver and Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Report from a Single-Centre Experience. Ann Surg Oncol 23 (Suppl 5), 666–673 (2016). https://doi.org/10.1245/s10434-016-5543-2

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  • DOI: https://doi.org/10.1245/s10434-016-5543-2

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