Failure analysis of recurrent disease following complete cytoreduction and Perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer

Background: The aim of this study was to analyze the anatomic distribution, timing, and outcomes of recurrent disease after complete cytoreduction and perioperative intraperitoneal chemotherapy (PIC) for peritoneal carcinomatosis of colorectal origin. Methods: Data regarding all patients who underwent complete cytoreduction and PIC for carcinomatosis from colorectal cancer were extracted from a prospectively collected database. The information regarding recurrent disease found on diagnostic evaluation and/or abdominal exploration was analyzed. Results: Seventy patients underwent complete cytoreduction and perioperative intraperitoneal chemotherapy, and 49 of them had documented recurrent disease. The median time to progression for these 49 patients was 9 months while their median survival was 30 months. Eighteen patients had a localized intra-abdominal recurrence, 10 had diffuse intraperitoneal recurrence, 10 had isolated distant metastases, and I I had a combination of distant metastases and intra-abdominal recurrence. There was a statistically significant difference in survival for patients with different patterns of recurrence (P = .012). Twenty-six patients underwent a second operation. The median survival of these patients was significantly longer than that of patients who did not have a second operation (39 vs 20 months, P = .0003). Four of the 49 patients with recurrences were still alive at the time of last follow-up, and three of them have no evidence of disease 73, 96, and 206 months after the diagnosis of recurrence. Conclusions: Recurrence is a frequent event after optimal cytoreduction and PIC for carcinomatosis from colorectal cancer. Surgical treatment for a selected group of patients with recurrent disease may result in long-term survival.