Abstract
Introduction
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is
an established treatment of Colorectal Peritoneal Metastases (CRPM). This study aims
to determine the timing and patterns of recurrent disease on imaging following complete
CRS/HIPEC.
Methods
Retrospective analysis of a national peritoneal tumour service database identified
CRPM patients with complete CRS/HIPEC(CC0) from 2005 to-2018. Patients with<2 years
follow-up or and those where post-operative histology from the CRS/HIPEC procedure
did not confirm CRPM from their original colorectal cancer were excluded. Time to
recurrence was measured from surgery to first radiologically illustrated recurrence.
CT was the primary modality used, supplemented by PET-CT or MRI if required. Outcomes
of interest were survival data (including overall survival (OS), disease-free survival
(DFS) and peritoneal-recurrence free survival (PRFS)), timing and patterns of recurrent
disease.
Results
146 of the 176 patients identified were eligible for inclusion. Median OS for all
study patients was 45.2 months (95% CI 38–53 months), median DFS was 11.7 months (95%
CI 9–14 months), and median PRFS was 25.2 months (95% CI 14.7–30 months). Recurrent
disease was seen in 112 cases (77%), radiologically classified as intraperitoneal
in 50 patients (44%), single site systemic in 21 patients (19%) and multi-site in
41 patients (37%). CT detection rate for disease recurrence was 88%. Subgroup analyses
showed that PCI ≥12, positive nodal primary disease and synchronous peritoneal disease
were associated with worse outcomes.
Conclusion
Patients selected for CRS/HIPEC for CRPM have an OS > 45 months, with the majority
recurring systemically within a year. Peritoneal recurrence is a later event after
several years. Surveillance programs in this group should be most intensive in the
first 2 years after surgery, using CT with oral and intravenous contrast.
Keywords
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Article info
Publication history
Published online: August 03, 2022
Accepted:
July 19,
2022
Received in revised form:
July 13,
2022
Received:
March 1,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
