Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

Eliza W Beal; Lorena P Suarez-Kelly; Charles W Kimbrough; Fabian M Johnston; Jonathan Greer; Daniel E Abbott; Courtney Pokrzywa; Mustafa Raoof; Byrne Lee; Travis E Grotz; Jennifer L Leiting; Keith Fournier; Andrew J Lee; Sean P Dineen; Benjamin Powers; Jula Veerapong; Joel M Baumgartner; Callisia Clarke; Harveshp Mogal; Marti C Russell; Mohammed Y Zaidi; Sameer H Patel; Vikrom Dhar; Laura Lambert; Ryan J Hendrix; John Hays; Sherif Abdel-Misih; Jordan M Cloyd

doi:10.3390/jcm9030748

Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

J Clin Med. 2020 Mar 10;9(3):748. doi: 10.3390/jcm9030748.

Authors

Eliza W Beal¹, Lorena P Suarez-Kelly¹, Charles W Kimbrough¹, Fabian M Johnston², Jonathan Greer², Daniel E Abbott³, Courtney Pokrzywa³, Mustafa Raoof⁴, Byrne Lee⁴, Travis E Grotz⁵, Jennifer L Leiting⁵, Keith Fournier⁶, Andrew J Lee⁶, Sean P Dineen⁷, Benjamin Powers⁷, Jula Veerapong⁸, Joel M Baumgartner⁸, Callisia Clarke⁹, Harveshp Mogal⁹, Marti C Russell¹⁰, Mohammed Y Zaidi¹⁰, Sameer H Patel¹¹, Vikrom Dhar¹¹, Laura Lambert¹², Ryan J Hendrix¹², John Hays¹, Sherif Abdel-Misih¹, Jordan M Cloyd¹

Affiliations

¹ Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA.
² Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD 21205, USA.
³ Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792, USA.
⁴ Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.
⁵ Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, USA.
⁶ Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 44907, USA.
⁷ Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, FL 33612, USA.
⁸ Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego, CA 92093, USA.
⁹ Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milkwaukee, WI 53226, USA.
¹⁰ Winship Cancer Institute, Division of Surgical Oncology, Emory University, Atlanta, GA 30322, USA.
¹¹ Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA.
¹² Department of Surgery, Division of Surgical Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA 45219, USA.

Abstract

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

Keywords: colorectal peritoneal metastases; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy.