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Zheng Y, Zhang J, Chen C, Gong Z, Wang Z, Deng Q, Yu S, Hu Y, Liu Y, Cao H, Xiao Q, Wang J, Ding K, Sun L. Prophylactic hyperthermic intraperitoneal chemotherapy in T4 colorectal cancer: Can it improve the oncologic prognosis? - A propensity score matching study. Eur J Surg Oncol 2024; 50:107958. [PMID: 38219698 DOI: 10.1016/j.ejso.2024.107958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Some studies show that cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) may improve overall survival and is a possible curative treatment for selected colorectal cancer (CRC) patients with restricted peritoneal metastasis (PM). The value of HIPEC in preventing PM of CRC is still controversial. MATERIALS AND METHODS In this retrospective propensity score matching (PSM) cohort study, all patients with cT4N0-2M0 undergoing treatment at a single institution in China (2014-2018) were reviewed. The 3-year disease-free survival (DFS) was set as the primary outcome, and the 3-year PM rate was also analyzed. RESULTS 220 patients were included in this study for analysis. After 1:3 PSM: HIPEC (n = 45) and No HIPEC (n = 135). Through analysis, it was found that prophylactic HIPEC correlated to better DFS [hazard ratio (HR) 0.43, 95 % confidence interval (CI) 0.19-0.95; p = 0.037], and N2 stage correlated to worse DFS [HR 1.97, 95 % CI 1.09-3.56; p = 0.025]. For laparoscopic surgery subgroup analyses, 3-year PM rate of patients with laparoscopic surgery was 13.8 % in No HIPEC group, and 2.6 % in HIPEC group (p = 0.070). Besides, no post-operative death occurred, the anastomotic leakage rate was 2.2 % in HIPEC group and 0.7 % in the control group (p = 0.439). CONCLUSIONS Prophylactic HIPEC may improve the prognosis in patients with cT4N0-1M0 CRC, but not in cT4N2M0 CRC, and it does not significantly increase surgery-related complications. Laparoscopic surgery followed by HIPEC for T4 stage CRC may not increase risk of PM.
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Affiliation(s)
- Yuyan Zheng
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Jingjing Zhang
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Chao Chen
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Zhiyuan Gong
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Zhanhuai Wang
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Qun Deng
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Shaojun Yu
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Yeting Hu
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Yue Liu
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Hongfeng Cao
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China
| | - Qian Xiao
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China; Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, Hangzhou, Zhejiang, China
| | - Jian Wang
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China; Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, Hangzhou, Zhejiang, China
| | - Kefeng Ding
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China; Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, Hangzhou, Zhejiang, China.
| | - Lifeng Sun
- Zhejiang University School of Medicine Second Affiliated Hospital, Colorectal Surgery, Hangzhou, Zhejiang, China; Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, Hangzhou, Zhejiang, China.
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Guo X, Lin Y, Shen C, Li Y, Zeng X, Lv J, Xiang F, Ruan T, Wu C, Tao K. Comparative Study of Short-Term Efficacy and Safety of Radical Surgery with or without Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer with T4 Stage: A Propensity Score Matching Analysis. J Clin Med 2023; 12. [PMID: 36769793 DOI: 10.3390/jcm12031145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) in T4 colorectal cancer (CRC) remains controversial. The study aimed to explore the safety and efficacy of radical surgery (RS) with HIPEC in T4 CRC. METHODS Adverse events after HIPEC were estimated by Common Terminology Criteria for Adverse Events version 5.0. The efficacy was evaluated using recurrence-free survival (RFS) and overall survival (OS). Propensity score matching (PSM) was used to reduce the effects of confounders between groups. RESULTS Of the 417 patients (263 men and 154 women), 165 patients were treated with RS + HIPEC and 252 patients with RS alone. There was no significant difference in the incidence of all adverse events after PSM. Overall RFS and OS were not significantly different at 24 months (p = 0.580 and p = 0.072, respectively). However, in patients with T4b stage CRC (92.1% vs. 77.3%, p = 0.048) and tumor size ≥ 5 cm (93.0% vs. 80.9%, p = 0.029), RFS in the two groups showed a significant difference at 24 months. CONCLUSIONS In summary, the safety of HIPEC in T4 CRC was confirmed. Compared with RS, though RS + HIPEC did not benefit the overall cohort at 24 months, RS + HIPEC could benefit patients with T4b stage CRC and tumor size ≥ 5 cm in RFS.
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