Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review

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

doi:10.3390/jcm9030748

Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review

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. RussellMohammed Y. Zaidi, Sameer H. Patel, Vikrom Dhar, Laura Lambert, Ryan J. Hendrix, John Hays, Sherif Abdel-Misih, Jordan M. Cloyd

Surgical Oncology

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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.

Original language	English (US)
Article number	748
Journal	Journal of Clinical Medicine
Volume	9
Issue number	3
DOIs	https://doi.org/10.3390/jcm9030748
State	Published - Mar 2020

Keywords

Colorectal peritoneal metastases
Cytoreductive surgery
Hyperthermic intraperitoneal chemotherapy

ASJC Scopus subject areas

General Medicine

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10.3390/jcm9030748

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Beal, E. W., Suarez-Kelly, L. P., Kimbrough, C. W., Johnston, F. M., Greer, J., Abbott, D. E., Pokrzywa, C., Raoof, M., Lee, B., Grotz, T. E., Leiting, J. L., Fournier, K., Lee, A. J., Dineen, S. P., Powers, B., Veerapong, J., Baumgartner, J. M., Clarke, C., Mogal, H., ... Cloyd, J. M. (2020). Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review. Journal of Clinical Medicine, 9(3), Article 748. https://doi.org/10.3390/jcm9030748

Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review. / Beal, Eliza W.; Suarez-Kelly, Lorena P.; Kimbrough, Charles W. et al.
In: Journal of Clinical Medicine, Vol. 9, No. 3, 748, 03.2020.

Research output: Contribution to journal › Article › peer-review

Beal, EW, Suarez-Kelly, LP, Kimbrough, CW, Johnston, FM, Greer, J, Abbott, DE, Pokrzywa, C, Raoof, M, Lee, B, Grotz, TE, Leiting, JL, Fournier, K, Lee, AJ, Dineen, SP, Powers, B, Veerapong, J, Baumgartner, JM, Clarke, C, Mogal, H, Russell, MC, Zaidi, MY, Patel, SH, Dhar, V, Lambert, L, Hendrix, RJ, Hays, J, Abdel-Misih, S & Cloyd, JM 2020, 'Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review', Journal of Clinical Medicine, vol. 9, no. 3, 748. https://doi.org/10.3390/jcm9030748

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title = "Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review",

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.",

keywords = "Colorectal peritoneal metastases, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy",

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

note = "Publisher Copyright: {\textcopyright} 2020 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2020",

month = mar,

doi = "10.3390/jcm9030748",

language = "English (US)",

volume = "9",

journal = "Journal of Clinical Medicine",

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T1 - Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases

T2 - A multi-institutional retrospective review

AU - Beal, Eliza W.

AU - Suarez-Kelly, Lorena P.

AU - Kimbrough, Charles W.

AU - Johnston, Fabian M.

AU - Greer, Jonathan

AU - Abbott, Daniel E.

AU - Pokrzywa, Courtney

AU - Raoof, Mustafa

AU - Lee, Byrne

AU - Grotz, Travis E.

AU - Leiting, Jennifer L.

AU - Fournier, Keith

AU - Lee, Andrew J.

AU - Dineen, Sean P.

AU - Powers, Benjamin

AU - Veerapong, Jula

AU - Baumgartner, Joel M.

AU - Clarke, Callisia

AU - Mogal, Harveshp

AU - Russell, Marti C.

AU - Zaidi, Mohammed Y.

AU - Patel, Sameer H.

AU - Dhar, Vikrom

AU - Lambert, Laura

AU - Hendrix, Ryan J.

AU - Hays, John

AU - Abdel-Misih, Sherif

AU - Cloyd, Jordan M.

PY - 2020/3

Y1 - 2020/3

N2 - 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.

AB - 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.

KW - Colorectal peritoneal metastases

KW - Cytoreductive surgery

KW - Hyperthermic intraperitoneal chemotherapy

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U2 - 10.3390/jcm9030748

DO - 10.3390/jcm9030748

M3 - Article

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JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

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M1 - 748

ER -

Impact of neoadjuvant chemotherapy on the outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A multi-institutional retrospective review

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