The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

Flood, MP; Kong, JCH; Wilson, K; Mohan, H; Waters, PS; McCormick, JJ; Warrier, SK; Tie, J; Ramsay, R; Michael, M; Heriot, AG

Author(s): Flood, MP; Kong, JCH; Wilson, K; Mohan, H; Waters, PS; McCormick, JJ; Warrier, SK; Tie, J; Ramsay, R; Michael, M; Heriot, AG;
Details: Publication Year 2022-10,Volume 29,Issue #11,Page 6619-6631
Journal Title: Annals of Surgical Oncology
Publication Type: Review
Abstract: BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-recognised treatment option for the management of colorectal peritoneal metastases (CRPM). However, incorporating the routine use of neoadjuvant chemotherapy (NAC) into this management plan is controversial. METHODS: A systematic review and meta-analysis were conducted to evaluate the impact of neoadjuvant chemotherapy on perioperative morbidity and mortality, and long-term survival of patients with CRPM undergoing CRS and HIPEC. RESULTS: Twelve studies met the inclusion criteria (n = 2,463 patients). Ten were retrospective cohort, one was prospective cohort, and one was a prospective randomised by design. Patients who received NAC followed by CRS and HIPEC experienced no difference in major perioperative morbidity and mortality compared with patients who underwent surgery first (SF). There was no difference in overall survival at 3 years, but at 5 years NAC patients had superior survival (relative risk [RR] 1.31; 95% confidence interval [CI] 1.11-1.54, P < 0.001). There were no differences in 1- and 3-year, disease-free survival (DFS) between groups. Study heterogeneity was generally high across all outcome measures. CONCLUSIONS: Patients who received neoadjuvant chemotherapy did not experience any increase in perioperative morbidity or mortality. The potential improvement in 5-year overall survival in patients receiving NAC is based on limited confidence due to several limitations in the data, but not sufficiently enough to curtail its use. The practice of NAC in this setting will remain heterogeneous and guided by retrospective evidence until prospective, randomised data are reported.
Keywords: Antineoplastic Combined Chemotherapy Protocols/therapeutic use; *Colorectal Neoplasms/pathology; Combined Modality Therapy; Cytoreduction Surgical Procedures; Humans; *Hyperthermia, Induced; Neoadjuvant Therapy; *Peritoneal Neoplasms/secondary; Prospective Studies; Retrospective Studies; Survival Rate
Department(s): Surgical Oncology; Medical Oncology; Laboratory Research
PubMed ID: 35397737
Publisher's Version: https://doi.org/10.1245/s10434-022-11699-7
Open Access at Publisher's Site: https://doi.org/10.1245/s10434-022-11699-7
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-10-24 06:50:51

Last Modified: 2024-10-24 06:55:57