Authors (including presenting author) :
Chow FC (1), Wong PC (1), Wei R (1), Foo CC (1)(2)
Affiliation :
(1) Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital
(2) Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong
Introduction :
Cytoreductive surgery (complete removal of all peritoneal tumors), with the option of hyperthermic intraperitoneal chemotherapy, is now an established treatment option for patients with limited colorectal peritoneal metastases (CPM). Median overall survival exceeds 3 years or more in selected patient cohorts. This surgical option has gradually been offered to patients with higher peritoneal disease load or concomitant extra-peritoneal disease.
Objectives :
To audit on the survival outcomes of patients who underwent surgical treatment for CPM in Queen Mary Hospital between January 2017 and June 2024. Outcomes between two periods - first 2017 to 2020 with more stringent case selection criteria, and second 2021 to 2024 with slightly more extended criteria - were compared.
To describe on recent modification of practice and very early outcomes attained.
Methodology :
Retrospective review on all CPM patients who received curative-intent cytoreductive surgery in Queen Mary Hospital between January 2017 and June 2024. Survival analyses were conducted in terms of overall and disease-free survivals.
Qualitative description on recent alterations of practice, based on evidence in the literature.
Result & Outcome :
Thirty-six CPM patients were included in the retrospective survival analyses. Sixteen (44.4%) were male and the median age was 61 years (range 26-76). The median operative time was 363 minutes (range 192-850), and complete disease clearance (CC-0 resection) were attained in all patients. The median overall and disease-free survivals were 41 months (95%CI 31.5-50.5) and 9.0 months (5.9-12.2).
Comparing period 1 and 2, the overall and disease-free survivals both shortened - 89 vs 32 months (p=0.018) and 11 vs 8 months (p=0.092) respectively. This could be explained by patients in the second period having a higher peritoneal disease load (median peritoneal cancer index 4 vs 6), more aggressive tumor biology (15.8% vs 41.1% being mucinous or signet ring cancer) and more extraperitoneal metastases (15.8% vs 23.5%).
Certain practice modifications have been commenced since 2024 in an effort to improve treatment outcome, including standardized recommendation on perioperative systemic anticancer treatment, improved surgical techniques and a more personalized treatment approach.
