Safety and efficacy of combined resection of colorectal peritoneal and liver metastases

Stephanie Downs-Canner, Yongli Shuai, Lekshmi Ramalingam, James F. Pingpank, Matthew P. Holtzman, Herbert J. Zeh, David L. Bartlett, Haroon A. Choudry

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background To determine if a select subgroup of patients with combined liver and peritoneal colorectal metastases would derive oncologic benefit from surgical resection as a component of multimodality treatment. Materials and methods We retrospectively compared 32 patients with combined colorectal peritoneal and liver metastases (CRLM) and 173 patients with peritoneal metastases only (CRPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC). Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting survival. Results Major postoperative complications (Clavien-Dindo grades 3-5) occurred in 32% (CRLM) and 17% (CRPM) of patients (P = 0.08). After an estimated median follow-up from surgery of 57 mo, propensity score–adjusted median progression-free survival was 5.1 mo (CRLM) and 7.6 mo (CRPM), whereas median overall survival was 13 mo (CRLM) and 21 mo (CRPM). Multivariate Cox-regression analysis of the CRLM group identified number of liver metastases to be the only independent predictor of poor survival (hazard ratio: 2.3, P = 0.03), with a dramatic decrease in survival in patients with more than three liver metastases. Conclusions Simultaneous resection of colorectal liver metastases at the time of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion for peritoneal metastases may be associated with worse survival, especially in patients with more than three liver metastases.

Original languageEnglish (US)
Pages (from-to)194-201
Number of pages8
JournalJournal of Surgical Research
Volume219
DOIs
StatePublished - Nov 2017
Externally publishedYes

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Neoplasm Metastasis
Safety
Liver
Survival
Kaplan-Meier Estimate
Proportional Hazards Models
Disease-Free Survival
Regression Analysis
catch-relaxing peptide (Mytilus)

Keywords

  • Colorectal cancer
  • Cytoreductive surgery
  • HIPEC
  • Metastases

ASJC Scopus subject areas

  • Surgery

Cite this

Downs-Canner, S., Shuai, Y., Ramalingam, L., Pingpank, J. F., Holtzman, M. P., Zeh, H. J., ... Choudry, H. A. (2017). Safety and efficacy of combined resection of colorectal peritoneal and liver metastases. Journal of Surgical Research, 219, 194-201. https://doi.org/10.1016/j.jss.2017.05.126

Safety and efficacy of combined resection of colorectal peritoneal and liver metastases. / Downs-Canner, Stephanie; Shuai, Yongli; Ramalingam, Lekshmi; Pingpank, James F.; Holtzman, Matthew P.; Zeh, Herbert J.; Bartlett, David L.; Choudry, Haroon A.

In: Journal of Surgical Research, Vol. 219, 11.2017, p. 194-201.

Research output: Contribution to journalArticle

Downs-Canner, S, Shuai, Y, Ramalingam, L, Pingpank, JF, Holtzman, MP, Zeh, HJ, Bartlett, DL & Choudry, HA 2017, 'Safety and efficacy of combined resection of colorectal peritoneal and liver metastases', Journal of Surgical Research, vol. 219, pp. 194-201. https://doi.org/10.1016/j.jss.2017.05.126
Downs-Canner, Stephanie ; Shuai, Yongli ; Ramalingam, Lekshmi ; Pingpank, James F. ; Holtzman, Matthew P. ; Zeh, Herbert J. ; Bartlett, David L. ; Choudry, Haroon A. / Safety and efficacy of combined resection of colorectal peritoneal and liver metastases. In: Journal of Surgical Research. 2017 ; Vol. 219. pp. 194-201.
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abstract = "Background To determine if a select subgroup of patients with combined liver and peritoneal colorectal metastases would derive oncologic benefit from surgical resection as a component of multimodality treatment. Materials and methods We retrospectively compared 32 patients with combined colorectal peritoneal and liver metastases (CRLM) and 173 patients with peritoneal metastases only (CRPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC). Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting survival. Results Major postoperative complications (Clavien-Dindo grades 3-5) occurred in 32{\%} (CRLM) and 17{\%} (CRPM) of patients (P = 0.08). After an estimated median follow-up from surgery of 57 mo, propensity score–adjusted median progression-free survival was 5.1 mo (CRLM) and 7.6 mo (CRPM), whereas median overall survival was 13 mo (CRLM) and 21 mo (CRPM). Multivariate Cox-regression analysis of the CRLM group identified number of liver metastases to be the only independent predictor of poor survival (hazard ratio: 2.3, P = 0.03), with a dramatic decrease in survival in patients with more than three liver metastases. Conclusions Simultaneous resection of colorectal liver metastases at the time of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion for peritoneal metastases may be associated with worse survival, especially in patients with more than three liver metastases.",
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AU - Downs-Canner, Stephanie

AU - Shuai, Yongli

AU - Ramalingam, Lekshmi

AU - Pingpank, James F.

AU - Holtzman, Matthew P.

AU - Zeh, Herbert J.

AU - Bartlett, David L.

AU - Choudry, Haroon A.

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N2 - Background To determine if a select subgroup of patients with combined liver and peritoneal colorectal metastases would derive oncologic benefit from surgical resection as a component of multimodality treatment. Materials and methods We retrospectively compared 32 patients with combined colorectal peritoneal and liver metastases (CRLM) and 173 patients with peritoneal metastases only (CRPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC). Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting survival. Results Major postoperative complications (Clavien-Dindo grades 3-5) occurred in 32% (CRLM) and 17% (CRPM) of patients (P = 0.08). After an estimated median follow-up from surgery of 57 mo, propensity score–adjusted median progression-free survival was 5.1 mo (CRLM) and 7.6 mo (CRPM), whereas median overall survival was 13 mo (CRLM) and 21 mo (CRPM). Multivariate Cox-regression analysis of the CRLM group identified number of liver metastases to be the only independent predictor of poor survival (hazard ratio: 2.3, P = 0.03), with a dramatic decrease in survival in patients with more than three liver metastases. Conclusions Simultaneous resection of colorectal liver metastases at the time of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion for peritoneal metastases may be associated with worse survival, especially in patients with more than three liver metastases.

AB - Background To determine if a select subgroup of patients with combined liver and peritoneal colorectal metastases would derive oncologic benefit from surgical resection as a component of multimodality treatment. Materials and methods We retrospectively compared 32 patients with combined colorectal peritoneal and liver metastases (CRLM) and 173 patients with peritoneal metastases only (CRPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC). Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting survival. Results Major postoperative complications (Clavien-Dindo grades 3-5) occurred in 32% (CRLM) and 17% (CRPM) of patients (P = 0.08). After an estimated median follow-up from surgery of 57 mo, propensity score–adjusted median progression-free survival was 5.1 mo (CRLM) and 7.6 mo (CRPM), whereas median overall survival was 13 mo (CRLM) and 21 mo (CRPM). Multivariate Cox-regression analysis of the CRLM group identified number of liver metastases to be the only independent predictor of poor survival (hazard ratio: 2.3, P = 0.03), with a dramatic decrease in survival in patients with more than three liver metastases. Conclusions Simultaneous resection of colorectal liver metastases at the time of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion for peritoneal metastases may be associated with worse survival, especially in patients with more than three liver metastases.

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