Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Cancer Med. 2023 Feb;12(3):2861-2868. doi: 10.1002/cam4.5195. Epub 2022 Sep 7.
Colorectal cancer with peritoneal metastasis (PM) has been considered a non-curative disease. PM is associated with reduced overall survival (OS) and worse prognosis compared with metastasis at other sites. We aimed to investigate the treatment outcome and recurrence after curative resection of colorectal PM during a long-term follow-up.
Patients who were diagnosed with colorectal PM and underwent surgery between December 2001 and December 2019 were included (n = 309). Curative resection was defined as PM resection without residual disease after surgery (complete macroscopic resection).
Of 309 patients, 208 (67.8%) had PM as an initially metastatic disease. Curative (R0/1) resection was achieved in 155 (50.2%) patients, while non-curative operation (R2 resection or palliative operation including colostomy) was performed in 154 (49.8%) patients. Compared with patients who underwent non-curative operation, those with curative resection more often had a single PM on preoperative imaging (34.2% vs. 20.8%, p = 0.011) and postoperative results (59.4% vs. 22.7%, p < 0.001) and less often had concurrent metastasis (distant lymph node, liver, or lung) at the time of surgery (p < 0.001). During a median follow-up of 90.4 months, 80.6% (125/155) patients had recurrence in the curative resection group; the peritoneum was the most common site (56.0%). The median OS was 47.7 months (95% CI, 39.2-56.2) in the curative resection group and 24.8 months (95% CI, 20.8-28.9) in the non-curative resection group, respectively (p < 0.001). In particular, twenty-six patients without recurrence showed long-term survival after curative resection (median OS, 87.1 months; range, 40.1-127.5).
Surgical resection can be considered for selected patients with colorectal PM because a significant number of them could seize the cure changes during their treatment continuum.
结直肠癌伴腹膜转移（PM）被认为是一种无法治愈的疾病。与其他部位转移相比，PM 与总生存期（OS）降低和预后更差相关。我们旨在研究长期随访中根治性切除结直肠 PM 后的治疗结果和复发情况。
纳入 2001 年 12 月至 2019 年 12 月期间诊断为结直肠 PM 并接受手术治疗的患者（n=309）。根治性切除定义为术后无残留疾病的 PM 切除（完全肉眼切除）。
309 例患者中，208 例（67.8%）PM 为首发转移疾病。155 例（50.2%）患者行根治性（R0/1）切除，154 例（49.8%）患者行非根治性手术（R2 切除或姑息性手术，包括结肠造口术）。与非根治性手术患者相比，根治性切除患者术前影像学检查（34.2%比 20.8%，p=0.011）和术后结果（59.4%比 22.7%，p<0.001）中更常出现单个 PM，且手术时同时存在远处淋巴结、肝或肺转移的情况更少（p<0.001）。在中位随访 90.4 个月期间，根治性切除组 80.6%（125/155）患者复发；最常见的部位是腹膜（56.0%）。根治性切除组的中位 OS 为 47.7 个月（95%CI，39.2-56.2），非根治性切除组为 24.8 个月（95%CI，20.8-28.9），差异具有统计学意义（p<0.001）。特别是 26 例无复发患者根治性切除后获得长期生存（中位 OS，87.1 个月；范围，40.1-127.5）。
对于选择的结直肠 PM 患者，可以考虑手术切除，因为他们中有相当一部分患者在治疗过程中可能获得治愈机会。
