Introduction Peritoneal metastases complicate 10 to 30% of patients with colorectal cancer.1Peritoneal carcinomatosis is traditionally associated with palliative care and a life expectancy measured in months.2Modern multiagent systemic chemotherapy prolongs survival in such cases to 18 months but many patients (60%) fail to complete the course due to side effects. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective treatments for advanced colorectal cancer with peritoneal metastases allowing median survival of up to 62 months and 5 year survival in excess of 40%.3These modalities are being employed in Ninewells Hospital in Dundee, since 2009.
Method Prospectively collected data from consecutive colorectal cancer patients with peritoneal metastases undergoing CRS and HIPEC. Patients were selected at multi-disciplinary meeting if expected peritoneal cancer index was less than 20 in abscence of significant comorbidities. Staging included CT chest abdomen and pelvis, PET scan and selected patients underwent a pre-operative staging laparoscopy to confirm disease extent. Following resection of all macroscopically visible disease the abdomen is closed and perfused with heated oxaliplatin and synchronous intravenous 5FU according to the Villejuif protocol. Patients are routinely admitted to ICU for at least 24 h.
Results Since August2009,43 patients with colorectal cancer peritoneal metastases have been treated with a mean age of 55 years (20 to 78) and a median hospital stay of 24 days. 40% of patients experienced complications post operatively (23% Clavien-Dindo 3 and 4) 3 patients had a return to theatre (left colonic ischaemia, small bowel fistula, wound dehiscence). Most complicaitons were managed percutaneously with radiologically placed drains. There were no deaths. The median peritoneal cancer index was 19 (last 8 cases:12). Multi-visceral resections accounted for 68% of the cases, 53% had isolated peritoneal metastases whilst 47% had been treated for synchronous or metachronous liver metastatic disease. Completeness of cytoreduction (R0) was achieved in 98% (1 patient). Median survival at 12 months is 79%, 18 months 69%, 48% at 24 months and 37% at 60 months.
Conclusion Radical resection and HIPEC for colorectal cancer peritoneal metastases are safe in selected patients and long term survival is possible even in the presence of liver metastatic disease.
Disclosure of interest None Declared.
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