Prognostic impact of completeness of cytoreduction and pelvic disease in CRS-HIPEC for colorectal peritoneal metastases
Asian Journal of Surgery, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.asjsur.2026.09.062
- Dergi Adı: Asian Journal of Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
- Anahtar Kelimeler: Colorectal cancer, Cytoreductive surgery, HIPEC, Pelvic involvement, Peritoneal cancer index, Peritoneal metastasis
- Lokman Hekim Üniversitesi Adresli: Evet
Özet
Background: Complete cytoreduction remains central to the management of colorectal peritoneal metastases, but the relationship among peritoneal disease burden, pelvic involvement, and cytoreductive feasibility remains incompletely defined. This study evaluated long-term outcomes after CRS-HIPEC and explored how pelvic disease and PCI interact with completeness of cytoreduction. Methods: We retrospectively reviewed 74 patients with colorectal peritoneal metastases who underwent CRS-HIPEC between 2010 and 2025 within a multidisciplinary program. Outcomes were overall survival (OS) and recurrence-free survival (RFS). PCI was analyzed using a cohort-specific cutoff of 15 and an exploratory three-level sensitivity analysis (<10, 10–20, >20). Cox regression evaluated prognostic factors. Results: Median OS was 21.7 months and median RFS was 15.1 months. CC0–1 cytoreduction was achieved in 51 patients (68.9%) and was the strongest favorable factor for OS (HR, 0.17; 95% CI, 0.08–0.35) and RFS (HR, 0.16; 95% CI, 0.08–0.34). In PCI-stratified analysis, pelvic involvement increased from 20.0% in PCI <10 to 90.0% in PCI >20, while CC0–1 rates decreased from 86.7% to 50.0%. Pelvic involvement was associated with inferior unadjusted outcomes and remained associated with OS, but its effect was attenuated in the RFS model after adjustment for PCI and CC score. Conclusion: CC0–1 was the dominant determinant of survival. PCI and pelvic involvement should be interpreted as interrelated markers of disease burden, anatomical complexity, and cytoreductive feasibility rather than isolated prognostic variables, supporting careful multidisciplinary selection.