Hayler Raymond, Garrett Celine, Guo Jessica, Barat Shoma, Sarofim Mina, Wijayawardana Ruwanthi, Ahmadi Nima, Liauw Winston, Morris David L
Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Australia.
School of Clinical Medicine, St George & Sutherland Campus, UNSW Medicine & Health, Sydney, Australia.
World J Surg Oncol. 2025 Jul 23;23(1):297. doi: 10.1186/s12957-025-03923-x.
Colorectal cancer is the third-most common malignancy worldwide. It has the potential to develop peritoneal metastases (CRPM), which can be treated using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). There is limited literature on outcomes of secondary CRS/HIPEC for CRPM recurrence.
All patients with CRPM who had secondary CRS/HIPEC between 2000 and 2023 were included. Clinical information regarding histological grade, peritoneal cancer index (PCI), completion of cytoreduction (CC), other metastases and their treatments, morbidity grade and demographics including sex, age and death were collected. The outcome of interest was peri-operative morbidity measured using Clavien-Dindo classification comparing with index CRS/HIPEC and survivals (disease-free survival (DFS) and overall survival (OS)). Secondary analyses were conducted to compare concurrent treatments and variables correlated with survivals.
Out of 435 patients who underwent CRS/HIPEC for colorectal cancer, 65 underwent secondary CRS/HIPEC. The median PCI score at secondary CRS/HIPEC was 6 (range 0-18) compared to 8 at index CRS/HIPEC (p < 0.01), and the median CC score at secondary CRS/HIPEC was 0 (n = 59, 91%) compared to 0 (n = 65, 100%) at index CRS/HIPEC (mean 0.0 v 0.12, p = 0.02). HIPEC was given in 59/65 patients (90%). Ten patients (15%) had radio- or microwave ablation to lung/liver metastases. Significant Clavien-Dindo morbidity (≥ 3) was similar between index and secondary operation with 13 (23%) of patients and 12 (19%) respectively. Median length of stay was 17 days. Median DFS after secondary CRS/HIPEC was 10.7 months, with an OS of 31.1 months. From index CRS/HIPEC, OS was 65.2 months. There was no difference by histological grade and no difference in DFS or OS in those who had had ablation. PCI at secondary operation was negatively associated with OS (r=-0.32, p = 0.009).
Secondary CRS/HIPEC for patients with CRC recurrence has comparable perioperative morbidity and mortality to index CRS/HIPEC, with significant disease-free and overall survival. Ablation of oligometastatic or extra-abdominal disease allows for comparable survival post-secondary CRS/HIPEC. Secondary CRS/HIPEC should be considered in selected patients.
结直肠癌是全球第三大常见恶性肿瘤。它有可能发生腹膜转移（CRPM），可采用细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）进行治疗。关于CRPM复发的二次CRS/HIPEC治疗结果的文献有限。
纳入2000年至2023年间接受二次CRS/HIPEC治疗的所有CRPM患者。收集有关组织学分级、腹膜癌指数（PCI）、细胞减灭完成情况（CC）、其他转移灶及其治疗、发病分级以及包括性别、年龄和死亡情况在内的人口统计学资料。感兴趣的结果是使用Clavien-Dindo分类法测量的围手术期发病率，并与初次CRS/HIPEC和生存率（无病生存率（DFS）和总生存率（OS））进行比较。进行二次分析以比较同期治疗以及与生存率相关的变量。
在435例接受CRS/HIPEC治疗的结直肠癌患者中，65例接受了二次CRS/HIPEC。二次CRS/HIPEC时的PCI中位数为6（范围0 - 18），而初次CRS/HIPEC时为8（p < 0.01）；二次CRS/HIPEC时的CC中位数为0（n = 59，91%），初次CRS/HIPEC时为0（n = 65，100%）（均值0.0对0.12，p = 0.02）。65例患者中有59例（90%）接受了HIPEC。10例患者（15%）对肺/肝转移灶进行了射频或微波消融。初次手术和二次手术中Clavien-Dindo分级显著的发病率（≥3级）相似，分别为13例（23%）患者和12例（19%）患者。中位住院时间为17天。二次CRS/HIPEC后的中位DFS为10.7个月，OS为31.1个月。从初次CRS/HIPEC开始计算，OS为65.2个月。组织学分级无差异，进行消融的患者在DFS或OS方面也无差异。二次手术时的PCI与OS呈负相关（r = -0.32，p = 0.009）。
结直肠癌复发患者的二次CRS/HIPEC与初次CRS/HIPEC具有相当的围手术期发病率和死亡率，同时具有显著的无病生存率和总生存率。对寡转移或腹外疾病进行消融可使二次CRS/HIPEC后的生存率相当。对于选定的患者应考虑进行二次CRS/HIPEC。
