Akiyoshi Mizumoto, Nobuyuki Takao, Toru Imagami, Byonggu An, Yasumitsu Oe, Takeshi Togawa, Yutaka Yonemura

Cytoreductive surgery for synchronous and metachronous colorectal peritoneal dissemination: Japanese P classification and peritoneal cancer index

  • Gastroenterology
  • Surgery
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AbstractAimThe outcomes of cytoreductive surgery (CRS) for synchronous and metachronous colorectal peritoneal dissemination were investigated using the Japanese P classification and peritoneal cancer index (PCI).MethodsCRS was performed in 111 cases of synchronous peritoneal dissemination and 115 cases of metachronous peritoneal dissemination. The P classification and PCI were determined at the time of laparotomy.ResultsIn the synchronous dissemination group, the 5‐year overall survival rates after CRS in P1/P2 and P3 cases were 51% and 13%, respectively. Even for P3, 51% of the patients achieved macroscopic cytoreductive complete resection (CC‐0), with a 5‐year survival rate of 40%. When P3 cases were classified into PCI 0–9, 10–19, 20–29, and 30–39, CC‐0 was achieved in 93%, 70%, 6%, and 0% of the cases, respectively, and the 5‐year survival rate of PCI 0–9 was 41%. In the metachronous dissemination group, the 5‐year survival rates were 62% for PCI 0–9 and 22% for PCI 10–19; 5‐year survival was not observed in patients with a PCI ≥ 20. CC‐0 was significantly associated with the postoperative prognosis in both synchronous and metachronous peritoneal dissemination.ConclusionIn cases of synchronous dissemination, CRS must be performed for P1 and P2 cases or those with a PCI < 10, while detailed examination using PCI is required for P3 cases. In cases of metachronous dissemination, CRS should be considered when the PCI score is <20.

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