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

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

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