Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis.

ABSTRACT:

Background

For patients with colorectal cancer (CRC) peritoneal metastases (PM) who are eligible for cytoreductive surgery (CRS), the indication and timing of systemic chemotherapy (SC) are still under debate. This study aims to analyze the role of pre, post or perioperative SC on the survival and surgical complications of patients treated with CRS-HIPEC.

Methods

After a systematic search in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science and Embase, a meta-analysis was performed to compare postoperative complications, disease-free survival (DFS) and overall survival (OS) according to SC administration and timing.

Prospero

CRD42023478977.

Results

Of 1203 studies screened, 15 were included in the meta-analysis (4523 patients). Post-operative SC was associated with increased overall survival (post-SC vs. no post-SC: HR 0.81, p = 0.00001, I² = 0%; pre-SC vs. post-SC: HR 0.65, p = 0.01, I² = 28%), whereas SC (pre or post) or pre-SC compared to surgery alone was not (SC vs. no SC: p = 0.29, I² = 80%; pre-SC vs. no pre-SC: p = 0.59, I² = 58%). Similar results were seen for DFS. SC was not associated with an increased complication rate (p = 0.47, I² = 64%).

Conclusions

Systemic chemotherapy administration in patients undergoing radical surgery for colorectal peritoneal metastases is associated with increased survival only in the adjuvant/post-operative setting. Considering the limitations of the included studies, further trials are needed to answer this unresolved question.

SUBMITTER: Tonello M 

PROVIDER: S-EPMC10969605 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature