Repeat cytoreductive surgery (CRS) for recurrent colorectal peritoneal metastases: yes or no?

Eur J Surg Oncol. 2014 Aug;40(8):943-9. doi: 10.1016/j.ejso.2013.10.022. Epub 2013 Nov 5.


Purpose: To clarify the role of repeat CRS for recurrent colorectal carcinoma (CRC) through: (i) Systematic review of the literature (ii) Analysis of survival outcomes in a prospective cohort.

Methods: (i) Pubmed and MEDLINE from 1980 to July 2013 searched using terms: colorectal carcinoma, peritonectomy, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), redo, repeat, and iterative. (ii) Kaplan-Meier Survival analysis of consecutive patients undergoing repeat CRS at St George Hospital between Jan 2000 and July 2013.

Results: (i) The search strategy yielded 309 articles, 5 meeting inclusion criteria, reporting on 91 patients. Median overall survival from first CRS ranged from 39 to 57.6 months with 3-yr survival of 50%, and 5-year survival of 30%. Median survival from second CRS was 20-months with 1-yr survivals of 72% and 66% and 2-year survivals of 50% and 44%. (ii) Repeat CRS performed on 18 patients found median survival from first CRS was 59 months, with 1, 3, and 5-year survival of 100%, 52% and 26% respectively. Median survival from repeat CRS was 22.6 months with 1, 2, and 3-year survival of 94%, 48% and 12% respectively.

Conclusion: The current data on repeat CRS in CRC is relatively immature and more data is required before drawing clear conclusions. Patient selection should be on a case by case basis conducted through a MDT process with emphasis on surrogate markers for favourable outcomes.

Keywords: Colorectal carcinoma; Cytoreductive surgery; Outcomes; Reoperation; Review; Surgery.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Carcinoma / secondary
  • Carcinoma / surgery*
  • Chemotherapy, Adjuvant
  • Chemotherapy, Cancer, Regional Perfusion* / methods
  • Colorectal Neoplasms / pathology*
  • Disease-Free Survival
  • Female
  • Humans
  • Hyperthermia, Induced*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / surgery*
  • Patient Selection
  • Peritoneal Cavity
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery*
  • Prospective Studies
  • Reoperation
  • Treatment Outcome