TY - JOUR
T1 - Patterns and Timing of Recurrence following CRS and HIPEC in Colorectal Cancer Peritoneal Metastasis
AU - Hassan, Sarah
AU - Malcomson, Lee
AU - Soh, Yen Jia
AU - Wilson, Malcom S.
AU - Clouston, Hamish
AU - O'Dwyer, Sarah T.
AU - Kochhar, Rohit
AU - Aziz, Omer
N1 - Funding Information:
Carefully selected use of appropriate imaging modality is important in the early detection and subsequent treatment of recurrent peritoneal disease. This study shows an 88% detection rate of peritoneal recurrence with CT which is supported by other recent studies that report 85–93% detection rate of peritoneal disease [26]. Historically, this figure was much lower at 60–80% but with improved CT resolution and a deeper understanding of the pathophysiologic mechanism of tumour spread, CT identification of peritoneal metastases has been shown to correlate with MRI [27] and laparotomy findings [28]. Peritoneal deposits of 5 mm are readily identifiable on CT [28]. The added benefit of MRI especially with customised protocols including DWI (diffusion weighted imaging) is its ability to identify deposits in anatomically difficult sites including sub-phrenic, mesenteric and bowel serosa [29,30]. It has previously been shown to be accurate in predicting the extent of peritoneal disease (sensitivity 80–90%, specificity 85–93%) and the DISCO randomised multicentre trial is aiming to determine whether it can be used to reduce the need for surgical staging [30].
Publisher Copyright:
© 2022
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - CRPM
KW - CRS and HIPEC
KW - Radiological patterns of recurrence
KW - Timing of recurrence
UR - http://www.scopus.com/inward/record.url?scp=85136103124&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2022.07.019
DO - 10.1016/j.ejso.2022.07.019
M3 - Article
C2 - 35987797
AN - SCOPUS:85136103124
SN - 0748-7983
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
ER -
