The benefits of repeated cytoreductive surgery and hyperthermic peritoneal chemotherapy in advanced colorectal cancer

This study investigated the benefits of repeated cytoreductive surgery (CRS) and hyperthermic peritoneal chemotherapy (HIPEC) in patients with advanced colorectal cancer. Researchers suggested that repeated treatment improves the survival of patients with advanced colorectal cancer, without an increase in side effects.

Colorectal cancer is a serious common condition. It is present in around 4% of the US population over 60 years of age. A significant number of these patients have metastatic (spread to other parts of the body) disease at diagnosis. A common site for metastasis in colorectal cancer is the peritoneum (membrane forming the lining of the abdominal organs).

CRS is a procedure that aims for the complete removal of visible tumors in the peritoneal area. HIPEC is a type of warm chemotherapy infused into the peritoneal area. This combined treatment is often given to these patients. However, recurrence (when cancer comes back) rates remain high. In these cases, repeat CRS/HIPEC may be considered.

Prior studies showed that repeating the treatment improves survival outcomes. However, these studies have limitations, such as a small number of participants. The effectiveness and safety of repeating treatment are not yet well understood.  

This study included 2157 patients with colorectal cancer and peritoneal metastasis. These patients were all treated with CRS/HIPEC. Of these, 158 (7.3%) repeated the treatment.

The overall presence of complications was similar between both groups (26.3% no-repat vs 30.7% repeat group). However, reoperation was more common in the repeat group. Length of stay and nonhome discharge were not significantly different.

5-year overall survival was 59.5% in the repeat group and 56% in the non-repeat group. In patients with cancer in the appendix, the 5-year survival was 67.3% in repeat group and 64% in the non-repeat group. In these patients, who had a recurrence, the average survival was 36 months in the no-repeat group and 73 months for those in the repat group.

This study concluded that repeat CRS/HIPEC improves the survival of patients with progressive colorectal cancer and peritoneal metastasis.

This study was based on medical records. Some information might have been incomplete. This might affect the results.