Article
Adequate primary surgical treatment is mandatory for the prognosis of patients with colon cancer and peritoneal metastasis suitable for cytoreduction and HIPEC treatment
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Authors
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Michael Ströhlein
- Klinikum Köln-Merheim, Universität Witten-Herdecke, Klinik für Viszeral-, Gefäss- und Transplantationschirurgie, Köln, Deutschland
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Panos Thomaidis
- Klinikum Köln-Merheim, Universität Witten-Herdecke, Klinik für Viszeral-, Gefäss- und Transplantationschirurgie, Köln, Deutschland
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Jonas Lange
- Klinikum Köln-Merheim, Universität Witten-Herdecke, Klinik für Viszeral-, Gefäss- und Transplantationschirurgie, Köln, Deutschland
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Markus Maria Heiss
- Klinikum Köln-Merheim, Universität Witten-Herdecke, Klinik für Viszeral-, Gefäss- und Transplantationschirurgie, Köln, Deutschland
| Published: | April 21, 2016 |
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Outline
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Background: Cytoreductive surgery (CRS) and Hyperthermic chemoperfusion (HIPEC) is the standard treatment for patients with colon cancer and resectable peritoneal metastasis. However, these patients are often diagnosed during emergency surgery for acute ileus when HIPEC treatment is not available and feasible. As a result, inadequate resection may be a relevant risk factor for patients receiving secondary HIPEC treatment. Aim of study was to investigate the role of primary surgical treatment.
Materials and methods: We investigated a series of 46 patients with peritoneal metastasis of colon cancer and complete CRS + HIPEC treatment for the influence of primary diagnosis and surgical treatment. Patients were assessed for ileus, emergency surgery, age, complete vs. incomplete resection, primary vs. secondary HIPEC and systemic chemotherapy. Log-rank analysis, student´s t-test and multivariate analysis were used for statistical calculation.
Results: Overall survival of patients with acute ileus was substantially lower compared to asymptomatic patients after complete CRS + HIPEC (16 vs 53 months, p=0.036). Surprising diagnosis of peritoneal metastasis after laparotomy was not a relevant risk factor (p=0.99). Patients with complete resection during primary surgery showed an increased survival compared to patients with R2 resection (12.5 vs. 52 months, p=0.001). There was no influence of systemic chemotherapy after primary resection.
Conclusion: The prognosis of patients with peritoneal metastasis of colon cancer crucially depends on adequate primary surgical treatment. Complete oncological resection of the primary tumor and peritoneal metastasis is mandatory. This is especially true for patients with emergency surgery for acute ileus.
