Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Ann Surg Oncol. 2020 Jul;27(7):2487-2497. doi: 10.1245/s10434-020-08242-x. Epub 2020 Feb 12.
Peritoneal recurrence (PR) of colorectal cancer is a poor prognostic factor but may be treatable by curative resection. We investigated the efficacy of this treatment and identified risk factors for postoperative recurrence.
The subjects were patients who underwent radical surgery for colorectal cancer between January 2006 and March 2014. Those with PR were retrospectively reviewed. Prognostic factors for overall survival (OS) and risk factors for postoperative recurrence were identified.
Among 2256 patients, 66 had PR (2.9%). Surgical resection of PR was performed in 41 patients. Curative resection was achieved macroscopically in 38 cases without diffuse metastases in the peritoneum distant from the primary tumor and with a peritoneal cancer index < 10. In multivariate analysis, curative resection was a significant prognostic factor [hazard ratio (HR) 0.198] for better 5-year OS compared with cases without curative resection (68.7% vs. 6.3%, P < 0.001). In 28 cases with concurrent metastasis, curative resection significantly improved 5-year OS compared with no curative resection (78.7% vs. 0%, P = 0.008). In the 38 patients with curative resection, the 3-year recurrence-free survival rate was 21.4%. In multivariate analysis, concurrent metastasis was a significant risk factor [HR 3.394] for postoperative recurrence, and cases with concurrent metastasis more frequently had recurrence within 2 years after curative resection.
Curative resection improved the prognosis in patients with limited and resectable PR of colorectal cancer with or without concurrent metastasis. However, recurrence after curative resection was common and concurrent metastasis was a risk factor for this recurrence.
结直肠癌腹膜复发（PR）是预后不良的因素，但通过根治性切除可能可治愈。我们研究了这种治疗方法的疗效，并确定了术后复发的危险因素。
研究对象为 2006 年 1 月至 2014 年 3 月期间接受根治性结直肠癌手术的患者。回顾性分析腹膜复发患者。确定总生存（OS）的预后因素和术后复发的危险因素。
在 2256 例患者中，有 66 例发生 PR（2.9%）。41 例患者行 PR 手术切除。在无弥漫性转移且腹膜癌指数（peritoneal cancer index，PCI）<10 的情况下，从原发肿瘤远处未发现弥漫性转移，38 例患者达到肉眼根治性切除。多因素分析显示，与未行根治性切除的患者相比，根治性切除是改善 5 年 OS 的显著预后因素（风险比[hazard ratio，HR]0.198）（68.7% vs. 6.3%，P<0.001）。在 28 例同时合并转移的患者中，根治性切除明显改善了 5 年 OS（78.7% vs. 0%，P=0.008）。在 38 例根治性切除的患者中，3 年无复发生存率为 21.4%。多因素分析显示，同时合并转移是术后复发的显著危险因素（HR 3.394），同时合并转移的患者在根治性切除后 2 年内更常复发。
对于有限和可切除的结直肠癌 PR 合并或不合并同时转移的患者，根治性切除可改善预后。然而，根治性切除后复发较为常见，同时合并转移是复发的危险因素。
