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Should we exclude patients with peritoneal carcinosis of colorectal origin and high PCI from CRS + HIPEC?

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Abstract

International guidelines exclude from surgery patients with peritoneal carcinosis of colorectal origin and a peritoneal cancer index (PCI) ≥ 16. This study aims to analyze the outcomes of patients with colorectal peritoneal carcinosis and PCI greater or equal to 16 treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (CRS + HIPEC). We retrospectively performed a multicenter observational study involving three Italian institutions, namely the IRCCS Policlinico San Matteo in Pavia, the M. Bufalini Hospital in Cesena, and the ASST Papa Giovanni XXIII Hospital in Bergamo. The study included all patients undergoing CRS + HIPEC for peritoneal carcinosis from colorectal origin from November 2011 to June 2022. The study included 71 patients: 56 with PCI < 16 and 15 with PCI ≥ 16. Patients with higher PCI had longer operative times and a statistically significant higher rate of not complete cytoreduction, with a Completeness of Cytoreduction score (CC) 1 (microscopical disease) of 30.8% (p = 0.004). The 2-year OS was 81% for PCI < 16 and 37% for PCI ≥ 16 (p < 0.001). The 2-years DFS was 29% for PCI < 16 and 0% for PCI ≥ 16 (p < 0.001). The 2-year peritoneal DFS for patients with PCI < 16 was 48%, and for patients with PCI ≥ 16 was 57% (p = 0.783). CRS and HIPEC provide reasonable local disease control for patients with carcinosis of colorectal origin and PCI ≥ 16. Such results form the basis for new studies to reassess the exclusion of these patients, as set out in the current guidelines, from CRS and HIPEC. This therapy, combined with new therapeutical strategies, i.e., pressurized intraperitoneal aerosol chemotherapy (PIPAC), could offer reasonable local control of the disease, preventing local complications. As a result, it increases the patient’s chances of receiving chemotherapy to improve the systemic control of the disease.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

No funding was received to assist with preparing this manuscript.

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Authors and Affiliations

  1. General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Paola Fugazzola, Alessandro Moroni, Lorenzo Cobianchi, Simone Frassini, Marcello Maestri, Matteo Tomasoni, Jacopo Viganò & Luca Ansaloni

  2. Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy

    Paola Fugazzola, Lorenzo Cobianchi & Luca Ansaloni

  3. Intensive Care Unit, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy

    Vanni Agnoletti

  4. General Surgery, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy

    Fausto Catena, Giorgia Santandrea & Carlo Vallicelli

  5. Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy

    Salvatore Corallo, Anna Pagani & Paolo Pedrazzoli

  6. Department of Management, Ca’ Foscari University of Venice, Venice, Italy

    Francesca Dal Mas

  7. General Surgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy

    Stefano Magnone & Andrea Rigamonti

  8. Department of Internal Medicine and Medical Therapy, University of Pavia, 27100, Pavia, Italy

    Paolo Pedrazzoli

Authors
  1. Paola Fugazzola
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  2. Alessandro Moroni
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  10. Stefano Magnone
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  11. Anna Pagani
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  16. Carlo Vallicelli
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  18. Luca Ansaloni
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Contributions

PF: conceptualization, data collection, data analysis, writing; LA: conceptualization, review, editing; AM: writing, data collection; F.C., L.C., FDM, J.V., P.P., A.P.: review and editing; S.F., S.M., AR, G.S., MT, CV: data collection and review. All the authors reviewed the final version of the paper and gave final approval for submission.

Corresponding author

Correspondence to Paola Fugazzola.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The current work was considered exempt from institutional board review due to the use of de-personalized information and its retrospective nature.

Human participants

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Due to the retrospective nature, consent for participation in the study was waived, and no direct referral to patient data was evident.

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Fugazzola, P., Moroni, A., Agnoletti, V. et al. Should we exclude patients with peritoneal carcinosis of colorectal origin and high PCI from CRS + HIPEC?. Updates Surg 75, 1819–1825 (2023). https://doi.org/10.1007/s13304-023-01579-4

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  • DOI: https://doi.org/10.1007/s13304-023-01579-4

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