System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 41576516 DOI: 10.1016/j.ejso.2026.111437

The clinical benefit of a near complete cytoreduction in patients with colorectal peritoneal metastases: a propensity score matched study.

Eur J Surg Oncol 52(3):111437

Authors: Peter H Cashin, David Morris, Jesus Esquivel, Stein Gunnar Larsen, Heikki Takala, Frédéric Dumont, Isabelle Sourrouille, Vahan Kepenekian, Jean-Jacques Tuech, Jean-Marc Bereder, Pablo Ortega-Deballon, Karine Abboud, Jean-Marc Regimbeau, Olivia Sgarbura, Olivier Glehen

Affiliations

  • Department of Surgical Sciences, Uppsala University, Sweden; Department of Surgery and Urology, Uppsala University Hospital (Akademiska sjukhuset), Sweden.
  • Department of Surgery, Peritonectomy Unit, St George Hospital & University of New South Wales, Australia.
  • Department of Surgical Oncology, Beebe Healthcare, Lewes, DE, USA.
  • Oslo University Hospital, Oslo, Norway.
  • Oulo University Hospital, Oulo, Finland.
  • Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, site de Saint Herblain, France.
  • Gustave Roussy, Département d'Anesthésie Chirurgie et Interventionnel, Villejuif, France.
  • Department of Digestive and Surgical Oncology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; CICLY, Université Claude Bernard Lyon 1, Lyon, France.
  • Department of General and Digestive Surgery, Hôpital Charles Nicole, Rouen, France.
  • FIAPro SAS, AI and Generative AI Training - Qualiopi Certified Organization, France.
  • CICLY: Centre d'Innovation en Chirurgie et parcours périopératoire personnalisé de la région LYonnaise, France.
  • Centre Hospitalier Universitaire d'Amiens-Picardie, France.
  • Department of Surgical Oncology, Institute of Cancer Montpellier, University of Montpellier, France; IRCM, Univ Montpellier, ICM, INSERM, Montpellier, France.

Abstract

BACKGROUND

Colorectal cancer with peritoneal metastases (PM) presents a significant therapeutic challenge. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is one option to prolong survival. While completeness of cytoreduction (CC) score 0 is associated with improved outcomes, the clinical value of near-complete CC-score 1 versus open-close laparotomy (CC-3) remains unclear.

METHODS

This retrospective study evaluates overall survival (OS) in patients with colorectal cancer PM scheduled for CRS and HIPEC from 23 global peritoneal-surface oncology centers from 2006 to 2023. A propensity score matching was performed using tumor location (colon/rectum), lymph node status, liver metastases, signet-ring histology, preoperative chemotherapy, peritoneal cancer index, and treatment year. Matching was performed using the nearest neighbor method with a caliper of 0.1, chosen after several iterations to optimize intergroup balance. Balance was assessed using standardized mean differences. Sensitivity analyses with alternative calipers and multivariable Cox regression in the unmatched cohort were considered to test the robustness of the findings. The study time-period was divided into 4 equal quartiles for analysis.

RESULTS

In the unmatched cohort (n = 284), patients with CC-1 had significantly longer median OS compared to those with CC-3 (22.2 vs. 9.4 months, p < 0.001). After 1:1 matching (n = 172), the OS advantage of CC-1 persisted, with a median OS of 18.9 months (95 % CI: 14.2-24.7) versus 10.5 months (95 % CI: 9.4-12.3) for CC-3, p < 0.0001, HR 0.4 (95 % CI:0.27-0.56). Multivariable Cox regression confirmed CC-1 as a significant predictor of survival (HR: 0.15, 95 % CI: 0.08-0.26). The CC-1 proportion went from 55 to 65 % in time-periods 1 & 2-39 % in period 3, to 11 % in period 4; leading to significantly reduced survival rates in the latter time-periods 3 & 4.

DISCUSSION

Near complete cytoreduction is associated with improved overall survival compared to open-close laparotomy. Prospective or standardized multicenter analyses will be required to confirm the clinical value of a near complete cytoreduction.

MeSH

Neoplasms, Hyperthermic Intraperitoneal Chemotherapy, Propensity Score, Drug Therapy, Neoplasm Metastasis, Therapeutics, Laparotomy, Chemotherapy