Heated Intraperitoneal Chemotherapy For Peritoneal Carcinomatosis From Colon Cancer: Prognostic Factor Analysis On 46 Patients

4083 Backgound: Peritoneal carcinomatosis affects 10% of patients with colorectal cancer at diagnosis and 20% with recurrent disease. Prognosis has been regarded as poor, but recent success of treatment with curative intend combining surgery with heated intraperitoneal chemotherapy (HIPEC) are reported. The aim of study is to determine prognostic factors in a single center cohort. Methods: Patient eligibility criteria were peritoneal carcinomatosis without extra-abdominal disease in colon cancer (appendix cancer excluded), age up to 75 years. Peritoneal Cancer Index (PCI) assess tumor load and completeness cytoreductive score (CCS) was used to give quality of resection CC0 (no visible tumor), CC1 (persistent diffuse lesions < 2.5mm), CC2 (2.5mm< CC2 < 25mm ) and over CC3 status. Peritonectomies and organ resections are performed. HIPEC is added using Mitomycine C (12 mg/m2 for men and 10 mg/m2 for the women) at 42° C by open technique over 90 minutes. Endpoint was survival. Kaplan-Meier survival curve was fitted to the data. Cox’s regression model was used for multivariate survival analysis. Results: We have operated on 48 procedures (HIPEC) in 46 consecutive patients from January 2000 to June 2007. The mean age was 52.7 years old range [32–75]. The mean PCI was 10 range [1–21]. After completion of resection the allocation of CCS was CC0=34, CC1=11, CC2=2. Procedure related mortality was null and morbidity 21.7% The mean length of hospital stay was 18.6 days range [7–57]. 5 years overall and progression free survival were respectively 40% and 20%. Median overall survival and progression free survival were 51 months and 34.5 months. A multivariate analysis showed prognostic factors for survival. Number of areas involved (HR= 1.7 CI 95 [1.17–2.55] p<0.006), Peritoneal location was prognostic factor: right subphrenic space (HR= 1.7 CI 95 [1.17–2.55] p<0.006) and mesentery involvement (HR = 4.03 CI 95 [1.46–11.1] p<0.007). Conclusions: The chemo-hyperthermia is a standardized and reproducible feasible method. Less extensive disease and the quality of cytoreduction remain an independent factor of better outcome. To date, HIPEC is a curative treatment in peritoneal carcinomatosis from colorectal origin, allowing to expect 5 years survival rate of 40%. No significant financial relationships to disclose.