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

• Main Authors: 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
• Format: Article
• Language: English
• Published: MDPI AG 2020-03-01
• Series: Journal of Clinical Medicine
• Subjects: cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; colorectal peritoneal metastases
• Online Access: https://www.mdpi.com/2077-0383/9/3/748

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&#8722;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, <i>p</i> = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, <i>p</i> = 0.650), readmission (32.3% vs. 23.5%, <i>p</i> = 0.114), or 30-day mortality (1.5% vs. 2.9%, <i>p</i> = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, <i>p</i> = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, <i>p</i> = 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.