Clinical

Surgery viable option for some colorectal cancers with peritoneal disease

Last Updated: 2008-10-07 16:29:35 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Although surgery is not generally used to treat peritoneal surface disease from colorectal cancer, the results of a new study suggest that at least in some cases, maybe it should be.

This conclusion is based on a comparison of surgery for peritoneal surface disease versus surgery for colorectal hepatic metastases, which is considered the treatment of choice in that situation. The findings, released in the September 30th online issue of the Annals of Surgical Oncology, suggest that the survival benefit achieved with the former is comparable to that of the latter.

"There have been no previous studies comparing these two disease presentations and their treatment outcomes," lead author Dr. Perry Shen, from Wake Forest University School of Medicine in Winston-Salem, North Carolina, told Reuters Health. The results indicate that surgery may be a reasonable option for some colorectal cancer patients with peritoneal surface disease, he added.

The study involved 121 patients with peritoneal surface disease who underwent cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy and 101 patients with hepatic metastases who underwent liver resection. Median follow-up periods were 86 and 56 months, respectively.

Fifty-five patients (45%) with peritoneal surface disease had complete resection of all gross tumor, which equates to a R0/R1 resection with the standard classification system. In the liver resection group, negative surgical margins were achieved in 95 patients (94%).

The peritoneal surface disease patients with R0/R1 resections had 1-, 3-, and 5-year overall survival rates of 91%, 48%, and 26%, respectively. The corresponding rates in the liver metastasis group were not significantly different: 87%, 59%, and 34%.

There were also no significant differences between peritoneal surface disease and hepatic metastasis patients in perioperative morbidity (42% vs. 34%) or mortality (5.5% vs. 4.2%).

These findings indicate that "patients with peritoneal surface disease from colorectal cancer should be evaluated at a peritoneal surface malignancy program," Dr. Shen emphasized. "Select patients may achieve long-term survival with this treatment approach in conjunction with systemic therapy."

Ann Surg Oncol 2008.