Department of Gastroenterological Surgery, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway.
Ann Surg. 2024 Nov 1;280(5):745-752. doi: 10.1097/SLA.0000000000006492. Epub 2024 Aug 26.
To study outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients also treated for colorectal liver metastases (CLM).
Colorectal cancer (CRC) frequently metastasizes to the liver and peritoneum and is associated with a poor prognosis. In selected patients, a benefit in overall survival (OS) was shown for both peritoneal metastases (PM-CRC) offered CRS-HIPEC, and CLM treated with surgical resection. However, the presence of CLM was considered a relative contraindication to CRS-HIPEC, causing a paucity of outcome data in this patient group.
Patients with PM-CRC having CRS-HIPEC at a single national center between 2007 and 2023, with additional intervention for CLM, were included (previous curative treatment for extraperitoneal and extrahepatic metastases was allowed). Three groups were defined: CLM before CRS-HIPEC (pre-CRS-HIPEC), CLM resected simultaneously with CRS-HIPEC (sim-CRS-HIPEC), and CLM after CRS-HIPEC (post-CRS-HIPEC), aiming to retrospectively analyze outcomes.
Fifty-seven patients were included and classified as: pre-CRS-HIPEC (n = 11), sim-CRS-HIPEC (n = 29), and post-CRS-HIPEC (n = 17). Median Peritoneal Cancer Index (PCI) was 8; 13 patients had severe complications (Clavien-Dindo ≥3), and no 90-day mortality. Median OS was 48 months after CRS-HIPEC. PCI was a predictor of OS (hazard ratio: 1.11, P < 0.001). We observed no difference in short or long-term outcomes between intervention groups.
This study demonstrated that patients with CLM having CRS-HIPEC had comparable OS to reports on CRS-HIPEC only, likely explained by a low PCI. Simultaneous CLM resection did not increase the risk of severe complications.
In this national cohort, CRS-HIPEC and CLM intervention offers long-term survival, suggesting that this treatment may be offered to selected patients with PM-CRC and CLM.
研究同时接受结直肠癌肝转移（CLM）治疗的患者接受细胞减灭术和腹腔热灌注化疗（CRS-HIPEC）后的结果。
结直肠癌（CRC）经常转移到肝脏和腹膜，预后不良。在选择的患者中，腹膜转移（PM-CRC）接受 CRS-HIPEC 和 CLM 手术切除均显示出总生存（OS）获益。然而，CLM 的存在被认为是 CRS-HIPEC 的相对禁忌症，导致该患者群体的结果数据很少。
纳入 2007 年至 2023 年期间在单一国家中心接受 CRS-HIPEC 治疗并同时接受 CLM 干预的 PM-CRC 患者（允许对腹膜外和肝外转移进行先前的治愈性治疗）。定义了三组：CRS-HIPEC 前的 CLM（pre-CRS-HIPEC）、与 CRS-HIPEC 同时切除的 CLM（sim-CRS-HIPEC）和 CRS-HIPEC 后的 CLM（post-CRS-HIPEC），旨在回顾性分析结果。
共纳入 57 例患者，分为 pre-CRS-HIPEC（n = 11）、sim-CRS-HIPEC（n = 29）和 post-CRS-HIPEC（n = 17）。中位腹膜癌指数（PCI）为 8；13 例患者发生严重并发症（Clavien-Dindo ≥3），无 90 天死亡率。CRS-HIPEC 后中位 OS 为 48 个月。PCI 是 OS 的预测因素（风险比：1.11，P < 0.001）。我们观察到干预组之间在短期和长期结果上没有差异。
本研究表明，接受 CRS-HIPEC 治疗的 CLM 患者与仅接受 CRS-HIPEC 治疗的报告具有相似的 OS，这可能归因于低 PCI。同时切除 CLM 并未增加严重并发症的风险。
在本国家队列中，CRS-HIPEC 和 CLM 干预可提供长期生存，这表明该治疗方法可提供给患有 PM-CRC 和 CLM 的选定患者。
