Short and long-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal and appendiceal cancer peritoneal metastasis: Propensity score-matched comparison between laparoscopy vs. open approaches

Sheng-Chi Chang; Abe Fingerhut; William Tzu-Liang Chen

doi:10.1016/j.suronc.2022.101766

Short and long-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal and appendiceal cancer peritoneal metastasis: Propensity score-matched comparison between laparoscopy vs. open approaches

Surg Oncol. 2022 Aug:43:101766. doi: 10.1016/j.suronc.2022.101766. Epub 2022 Apr 8.

Authors

Sheng-Chi Chang¹, Abe Fingerhut², William Tzu-Liang Chen³

Affiliations

¹ Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan. Electronic address: crschang001@gmail.com.
² Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz Austria and Department of General Surgery, Ruijin Hospital, Shanghai, Jiao Tong, PR China; University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, PR China.
³ Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Division of Colorectal Surgery, Department of Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. Electronic address: wtchen@mail.cmuh.org.tw.

PMID: 35430126
DOI: 10.1016/j.suronc.2022.101766

Abstract

Background: In light of today's role of minimally access surgery in colorectal oncologic treatment, we analyzed the impact of laparoscopic cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in selected patients with peritoneal metastases (PM) originating from colorectal and appendiceal cancer (CRAC).

Methods: Postoperative and oncologic outcomes were compared between patients with CRAC-PM treated by CRS/HIPEC undergoing laparoscopic (L-CRS/HIPEC) or open (O-CRS/HIPEC) procedures according to data collected from our tertiary referral hospital prospective database from April 2016 to April 2021. We excluded patients who did not undergo operation with curative intent. L-CRS was performed in patients who had no multifocal mesenteric lesions, no large abdominal mass, nor massive adhesions. Patients were matched by propensity scores 1:1 for peritoneal cancer index, completeness of cytoreduction score, concomitant resectable distal metastasis, primary tumor location, RAS mutation status and American Society of Anesthesiologists (ASA) classification.

Results: Of 106 eligible patients, 68 were matched (34 L-CRS/HIPEC; 34 O-CRS/HIPEC) by propensity scores. Compared with the open approach, L-CRS/HIPEC was associated with less overall surgical morbidities (14.7% vs. 38.2%; p = 0.028), shorter median hospital stay (10 [5-15] vs. 12 [8-33] days; p < 0.001) and reduced median waiting time before adjuvant chemotherapy (4.7 [3.0-13.2] vs. 5.7 [4.1-24.1] weeks; p = 0.047). No statistically significant difference was found in operative time or major morbidity rates between the two groups. After a median follow-up of 33.2 months, the rate of early peritoneal loco-regional recurrence, location of initial recurrence or 3-year survival outcomes were not statistically significantly related to the type of access (L-CRS/HIPEC vs. O-CRS/HIPEC).

Conclusions: Laparoscopy for CRS/HIPEC is technically feasible and oncologically safe to treat selected patients with CRAC-PM. Further randomized control trials are required to confirm the benefits of minimal access surgery for the management of PM.

Keywords: Colorectal appendiceal cancer; HIPEC; Laparoscopic cytoreductive surgery; Minimal invasive surgery; Peritoneal metastasis; Survival.

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Appendiceal Neoplasms* / drug therapy
Chemotherapy, Cancer, Regional Perfusion
Colorectal Neoplasms* / surgery
Combined Modality Therapy
Cytoreduction Surgical Procedures
Humans
Hyperthermia, Induced*
Hyperthermic Intraperitoneal Chemotherapy
Laparoscopy*
Peritoneal Neoplasms* / surgery
Propensity Score
Retrospective Studies