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Diagnostic Nodes of Patient Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Among Colorectal Cancer Patients: A Swiss National Multicenter Survey

Thomas Steffen, Paul Martin Putora, Martin Hübner, Beat Gloor, Kuno Lehmann, Christoph Kettelhack, Michel Adamina, Ralph Peterli, Jan Schmidt, Frédéric Ris & Markus Glatzer

abstract

BACKGROUND
The management of patients with colorectal cancer (CRC) with peritoneal metastases is challenging, and the roles of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are unclear and debated among experts.

MATERIALS AND METHODS
The experts of the Swiss Peritoneal Cancer Group were contacted and agreed to participate in this analysis. Experts from 9 centers in Switzerland provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Their responses were converted into decision trees on the basis of objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies.

RESULTS
The final treatment algorithms included a total of 5 decision criteria (age, Peritoneal Cancer Index [PCI], extraperitoneal metastases, Peritoneal Surface Disease Severity Score, and various risk factors [RF]) and 2 treatment options (HIPEC, yes or no). HIPEC was never recommended for patients without peritoneal metastases in the absence of RF for peritoneal metastases. For patients with a PCI ≤15 without organ metastases, all centers recommended CRS/HIPEC. There was also a consensus not to perform CRS/HIPEC in elderly patients (80 years and older), those with a PCI >20, and those with unresectable metastases. For patients with a PCI = 16 to 20, there was no consensus.

CONCLUSION
Multiple decision criteria relevant to all participating centers were identified. Because patient selection for CRS/HIPEC remains difficult, uniform criteria for the term "high risk" for peritoneal metastases and systemic metastases are helpful. Future trials and guidelines should take these criteria into account.
   
citation Steffen T, Putora P M, Hübner M, Gloor B, Lehmann K, Kettelhack C, Adamina M, Peterli R, Schmidt J, Ris F, Glatzer M. Diagnostic Nodes of Patient Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Among Colorectal Cancer Patients: A Swiss National Multicenter Survey. Clin Colorectal Cancer 2019; 18:e335-e342.
   
type journal paper/review (English)
date of publishing 26-06-2019
journal title Clin Colorectal Cancer (18/4)
ISSN electronic 1938-0674
pages e335-e342
PubMed 31371166
DOI 10.1016/j.clcc.2019.06.002