GPPO7: Perioperative and Oncological Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis of Rectal Origin
General Surgery Resident Department of General and Oncological Surgery - Surgery "C" - Chaim Sheba Medical Center
Introduction: The peritoneum is a common metastatic site of colorectal cancer (CRC) and is associated with worse oncological outcomes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve oncological outcomes in selected patients. Multiple studies showed significant difference in survival of patients with primary colon and rectal tumors. This could be attributed to differences in biological behavior and response to treatment. These differences were further demonstrated in the metastatic setting. Only few studies assessed the outcomes of CRS/HIPEC for primary rectal and colon tumors with conflicting outcomes. Here we studied the perioperative and oncological outcomes of patients undergoing CRS/HIPEC for rectal cancer.
Methods: A retrospective analysis of a prospectively maintained peritoneal surface malignancies database between 2007 and 2022 was performed. Data stratifying patients according to their primary tumor was reviewed.
Results: One hundred and ninety-nine (199) patients underwent CRS/HIPEC during this time period. We identified 172 patients with primary colon and 27 patients with primary rectal tumors. Patients with rectal primary tumors had a significantly longer surgery (mean duration 4.32 (±1.37) hours vs 5.26 (±1.60), p=0.0013), had increased blood loss (mean 441 (±312) cc vs 602 (±452) cc, p=0.021), required more blood transfusions (mean 0.77 (±1.24) vs 1.37 (±1.45) units, p=0.026) and had longer hospitalizations (mean 10 (8-15) vs 13 (10-26) days, p=0.02). The rates of post-operative complications were similar. Median disease-free survival was worse in the rectal primary group; 7.03 months vs 10.9 months for colon primary tumors (p=0.036). however, overall survival was not statistically significant; 53.2 months for rectal and 60.8 months for colon primary tumors. Multivariate analysis shows tumor location (colon vs rectum) and peritoneal carcinomatosis index (PCI) to be independently associated with DFS.
Conclusions: Our study, is to our knowledge, the largest reported cohort comparing outcomes of patients with rectal carcinoma undergoing CRS/HIPEC. We demonstrate worse perioperative and oncological outcomes in patients with PM from rectal carcinoma compared to colon carcinoma . Our findings are on par with published literature This data should be used for risk stratification when considering CRS/HIPEC for patients with rectal primary.