Abstract
Background: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome.
Methods: Patients having surgical debulking and IP 5-fluoro-2′-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively.
Results: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m2 daily for 3 days) and IP leucovorin (240 mg/m2) with a median cycle number of 4 (range, 1–28). The median number of complications was 1 (range, 0–5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0–132 months). The median survival was 34 months (range, 2–132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection.
Conclusions: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Sugarbaker PH, Cunliffe WJ, Belliveau J, et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol 1989; 16: 83–97.
Cohen AM, Winawer SJ. Cancer of the Colon, Rectum, and Anus. New York: McGraw-Hill, 1995.
Speyer JL. The rationale behind intraperitoneal chemotherapy in gastrointestinal malignancies. Semin Oncol 1985; 12: 23–8.
Gyves JW, Ensminger WD, Stetson P, et al. Constant intraperitoneal 5-fluorouracil infusion through a totally implanted system. Clin Pharmacol Ther 1984; 35: 83–9.
Jenkins J, Sugarbaker PH, Gianola FJ, Myers CE. Technical considerations in the use of intraperitoneal chemotherapy administered by Tenckhoff catheter. Surg Gynecol Obstet 1982; 154: 858–62.
Demicheli R, Jirillo A, Bonciarelli G, et al. Pharmacological data and technical feasibility of intraperitoneal 5-fluorouracil administration. Tumori 1982; 68: 437–41.
Sugarbaker PH, Graves T, DeBruijn EA, et al. Early postoperative intraperitoneal chemotherapy as an adjuvant therapy to surgery for peritoneal carcinomatosis from gastrointestinal cancer: pharmacological studies. Cancer Res 1990; 50: 5790–4.
Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol 1999; 43(Suppl): S15–25.
Markman M. Intraperitoneal chemotherapy in the management of colon cancer. Semin Oncol 1999; 26: 536–9.
Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role. Langenbecks Arch Surg 1999; 384: 576–87.
Sugarbaker PH. Treatment of peritoneal carcinomatosis from colon or appendiceal cancer with induction intraperitoneal chemotherapy. Cancer Treat Res 1996; 82: 317–25.
Sugarbaker PH. Peritoneal carcinomatosis: natural history and rational therapeutic interventions using intraperitoneal chemotherapy. Cancer Treat Res 1996; 81: 149–68.
Sugarbaker PH, Averbach AM, Jacquet P, et al. A simplified approach to hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) using a self retaining retractor. Cancer Treat Res 1996; 82: 415–21.
Sugarbaker PH, Schellinx ME, Chang D, et al. Peritoneal carcinomatosis from adenocarcinoma of the colon. World J Surg 1996; 20: 585–91;discussion, 592.
Sugarbaker PH. Intraperitoneal chemotherapy for treatment and prevention of peritoneal carcinomatosis and sarcomatosis. Dis Colon Rectum 1994; 37: S115–22.
Sugarbaker PH. Cytoreductive surgery and intraperitoneal chemotherapy with peritoneal spread of cystadenocarcinoma. Eur J Surg Suppl 1991; 561: 75–82.
Muggia FM, Chan KK, Russell C, et al. Phase I and pharmacologic evaluation of intraperitoneal 5-fluoro-2′-deoxyuridine. Cancer Chemother Pharmacol 1991; 28: 241–50.
Kelsen DP, Saltz L, Cohen AM, et al. A phase I trial of immediate postoperative intraperitoneal floxuridine and leucovorin plus systemic 5-fluorouracil and levamisole after resection of high risk colon cancer [see comments]. Cancer 1994; 74: 2224–33.
Graf W, Westlin JE, Pahlman L, Glimelius B. Adjuvant intraperitoneal 5-fluorouracil and intravenous leucovorin after colorectal cancer surgery: a randomized phase II placebo-controlled study. Int J Colorectal Dis 1994; 9: 35–9.
Scheithauer W, Kornek GV, Marczell A, et al. Combined intravenous and intraperitoneal chemotherapy with fluorouracil + leucovorin vs fluorouracil + levamisole for adjuvant therapy of resected colon carcinoma. Br J Cancer 1998; 77: 1349–54.
Vaillant JC, Nordlinger B, Deuffic S, et al. Adjuvant intraperitoneal 5-fluorouracil in high-risk colon cancer: a multicenter phase III trial [see comments]. Ann Surg 2000; 231: 449–56.
Kaplan E, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc 1958; 53: 457–81.
Buroker TR, O’Connell MJ, Wieand HS, et al. Randomized comparison of two schedules of fluorouracil and leucovorin in the treatment of advanced colorectal cancer [see comments]. J Clin Oncol 1994; 12: 14–20.
Saltz LB, Cox JV, Blanke C, et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group [see comments]. N Engl J Med 2000; 343: 905–14.
Alberts DS, Liu PY, Hannigan EV, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer [see comments]. N Engl J Med 1996; 335: 1950–5.
Markman M. Intraperitoneal chemotherapy. Semin Oncol 1991; 18: 248–54.
Barakat RR, Almadrones L, Venkatraman ES, et al. A phase II trial of intraperitoneal cisplatin and etoposide as consolidation therapy in patients with Stage II-IV epithelial ovarian cancer following negative surgical assessment. Gynecol Oncol 1998; 69: 17–22.
Markman M, Reichman B, Hakes T, et al. Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin. J Clin Oncol 1991; 9: 1801–5.
Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996; 77: 2622–9.
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented in part at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.
Rights and permissions
About this article
Cite this article
Culliford, A.T., Brooks, A.D., Sharma, S. et al. Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer. Ann Surg Oncol 8, 787–795 (2001). https://doi.org/10.1007/s10434-001-0787-9
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10434-001-0787-9