Limited survival in the treatment of carcinomatosis from rectal cancer

PURPOSE: Carcinomatosis from colon and rectal cancer has always been regarded as a lethal condition. Recently, numerous reports suggest that long-term survival is possible in selected patients if a definitive management strategy is used. An important task involves the clear description of the clinical features that influence prognosis in these patients. METHODS: From June 1981 to November 2004, 150 patients with peritoneal carcinomatosis secondary to colorectal cancer underwent cytoreductive surgery with perioperative intraperitoneal chemotherapy. Among these patients, 11 had rectal cancer with carcinomatosis and are the focus of the present study. The survival of patients with peritoneal carcinomatosis of rectal cancer origin was compared with patients with colon cancer. In the data analysis, patients were classified by completeness of cytoreduction score. RESULTS: The mean follow-tip for 11 patients with rectal cancer was 15.7 (range, 3-51) months. At the end of the cytoreductive surgery, the cytoreduction was complete in six patients, nearly complete in two patients, and there was gross disease in three patients. The median survival of the six rectal cancer patients with complete cytoreduction was 17 (range, 12-29) months and 35 (range, 3-241) months for 64 colon cancer patients with complete cytoreduction (P = 0. 126). The five-year survival for patients with rectal cancer with complete cytoreduction was 0 percent and for patients with colon cancer was 33 percent. CONCLUSIONS: Patients with peritoneal carcinomatosis secondary to rectal cancer treated by cytoreductive surgery combined with intraperitoneal chemotherapy have a poor prognosis. Some improvement in these poor results may occur if resection of a rectal cancer with carcinomatosis is delayed until definitive treatment of the primary cancer plus the carcinomatosis is possible.