Prognostic factors for early recurrences following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal peritoneal metastases

Abstract

Introduction: The introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved the prognosis of selected patients with peritoneal metastases (PM) of colorectal and appendiceal primaries. However, despite careful patient selection and complete macroscopic resection, early recurrences (ER) still occur. This study aims to identify risk factors for ER. Method(s): Patients with appendiceal and colorectal PM treated with CRS and HIPEC between January 2001 and June 2016 at the National Cancer Centre Singapore were analyzed. Comparison between patients who developed ER (< 12 months) and those with late recurrence (>12 months) or no recurrence was performed using univariate and multivariate analyses. Result(s): In the appendiceal group, 9 out of 58 patients (16%) developed ER. The median disease-free interval (DFI) of patients with ER was 10 months and in patients with no ER was 26 months. Univariate analysis identified male gender, elevated preoperative CEA levels, preoperative CA 19-9 levels and high PCI score as factors associated with ER. There were no significant factors for ER on multivariate analysis. For the colorectal cohort, 30 out of 83 patients (36%) developed ER. The median DFI of patients with ER was 11.5 months and in patients without ER it was 21 months. Univariate analysis identified that increased age, elevated CA-125 levels, high PCI score, intraoperative complications and longer length of hospital stay after CRS and HIPEC was associated with ER. Multivariate analysis identified elevated preoperative CA-125 levels as significantly associated with ER. Conclusion(s): ER is a considerable consequence in patients with peritoneal metastases of appendiceal and colorectal primaries. By identifying factors associated with ER, patients at risk may benefit from an alternative treatment strategy and follow up.