Journal of the Anus, Rectum and Colon (Jan 2025)

Factors Affecting the Prognosis after Primary Tumor Resection for Patients with Metastatic Colorectal Cancer with Synchronous Peritoneal Metastasis: A Multi-center, Prospective, Observational Study

  • Satoru Kagami,
  • Kimihiko Funahashi,
  • Hirotoshi Kobayashi,
  • Kenjiro Kotake,
  • Masayasu Kawasaki,
  • Yusuke Kinugasa,
  • Hideki Ueno,
  • Kotaro Maeda,
  • Takeshi Suto,
  • Michio Itabashi,
  • Heita Ozawa,
  • Fumikazu Koyama,
  • Shingo Noura,
  • Hideyuki Ishida,
  • Masayuki Ohue,
  • Tomomichi Kiyomatsu,
  • Soichiro Ishihara,
  • Keiji Koda,
  • Hideo Baba,
  • Kenji Kawada,
  • Yojiro Hashiguchi,
  • Takanori Goi,
  • Yuji Toiyama,
  • Naohiro Tomita,
  • Eiji Sunami,
  • Fumihiko Fujita,
  • Jun Watanabe,
  • Kenichi Hakamada,
  • Goro Nakayama,
  • Kenichi Sugihara,
  • Yoichi Ajioka

DOI
https://doi.org/10.23922/jarc.2024-056
Journal volume & issue
Vol. 9, no. 1
pp. 134 – 144

Abstract

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Objectives: To clarify the risk factors affecting prognosis after primary tumor resection (PTR) in patients with metastatic colorectal cancer with synchronous peritoneal metastasis (mCRC-SPM). Methods: Patients were enrolled prospectively in the JSCCR project “Grading of Peritoneal Seeding in Colorectal Cancer.” Factors that may influence overall survival―age, sex, location of the primary tumor, lymph node metastasis, presence of liver metastasis, degree of peritoneal metastasis, peritoneal cancer index (PCI), cancer cure, and postoperative chemotherapy―in the PTR group were examined using multivariate analysis. Results: Of the 133 enrolled patients with mCRC-SPM, 112 patients underwent PTR. Among them, 26 (23.2%) had mCRC-SPM of grade P1, 47 (42.0%) of P2, and 39 (34.8%) of P3. The median PCI was 4 (range, 1-28); no surgery-related deaths occurred. Postoperative complications of Clavien-Dindo classification grade 2 were observed in 20 (17.9%) patients. R0 surgery became more difficult as the degree of dissemination increased, and the PTR group had a significantly better prognosis than the non-PTR group. In the multivariate analysis, age 75 years, rectal cancer, presence of liver metastasis, higher PCI, non-curative resection, and non-treatment with systemic chemotherapy were associated with poor prognosis in patients after PTR. Conclusions: In patients with mCRC-SPM, postoperative complications are infrequent for P1 with localized peritoneal dissemination, and PTR may be considered as aggressive treatment. Factors including age 75 years, rectal cancer, presence of liver metastasis, increased PCI, non-curative resection, and non-treatment with systemic chemotherapy are associated with a reduced survival benefit from PTR.

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