European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Surgery for Colorectal Peritoneal Metastases in non-expert centers is strongly associated with tumor persistence or early recurrence: a bicentric study of 106 patients.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Noiret Barbara, Kepenekian Vahan, Leroy Maxime, Provost Marie, Rousset Pascal, Piessen Guillaume, Glehen Olivier, Eveno Clarisse
Аннотация
BACKGROUND: Complete cytoreductive surgery (CRS) performed in expert centers is a key determinant of outcome in patients with colorectal peritoneal metastases (CRPM). In the contemporary context of ongoing debate regarding the role of HIPEC following the PRODIGE 7 trial, the impact of initial management outside expert centers on outcomes remains insufficiently characterized. This study evaluates the value of systematic second-look surgeries in expert centers after CRS in non-expert centers.
METHODS: Patients with histologically confirmed CRPM who initially underwent surgery in non-expert centers followed by systematic second-look surgery in two expert centers were included between 2010 and 2022.
STATISTICAL ANALYSIS: Perioperative outcomes were evaluated in both surgeries. Preoperative imaging (CT-scan/MRI) were conducted before second-look surgeries and reviewed by expert radiologists. Survival outcomes were performed by Kaplan-Meier method.
RESULTS: Among 106 patients (50.9 % male, mean age 58.9 ± 10.8 years), all tumors were classified as pT3-4, with 87 % having synchronous CRPM. Initial CRS in non-expert centers was performed urgently in 35 % of cases, primarily due to occlusion or perforation (62.1 %). Complete cytoreduction (CC0) was declared in 63 % of initial CRS. Reassessment (CT/MRI) before second-look was highly predictive of intraoperative and histological presence of CRPM, but intraoperative CRPM detection occurred in 61 % (CT-negative) and 81 % (MRI-negative) with histological confirmation in 53 % and 42 %. During second-look surgery, CRPM was observed in 88 % of cases (median PCI score:6) and 11.3 % were unresectable. Median overall survival (OS) was 43 months with 1- and 5-year OS of 95 % and 34.3 %, respectively. Prognostic factors of lower OS included poorly cohesive histology, emergency surgery and incomplete cytoreduction during first surgery in non-expert centers.
CONCLUSIONS: In patients with CRPM initially managed in non-expert centers, expert-center reassessment, including consideration of second-look surgery, identifies persistent or recurrent peritoneal disease in a substantial proportion of patients, even in the absence of radiological evidence. These findings support the importance of early referral to expert centers for comprehensive evaluation and multidisciplinary decision-making. The impact of second-look strategies on survival outcomes warrants further prospective investigation.
METHODS: Patients with histologically confirmed CRPM who initially underwent surgery in non-expert centers followed by systematic second-look surgery in two expert centers were included between 2010 and 2022.
STATISTICAL ANALYSIS: Perioperative outcomes were evaluated in both surgeries. Preoperative imaging (CT-scan/MRI) were conducted before second-look surgeries and reviewed by expert radiologists. Survival outcomes were performed by Kaplan-Meier method.
RESULTS: Among 106 patients (50.9 % male, mean age 58.9 ± 10.8 years), all tumors were classified as pT3-4, with 87 % having synchronous CRPM. Initial CRS in non-expert centers was performed urgently in 35 % of cases, primarily due to occlusion or perforation (62.1 %). Complete cytoreduction (CC0) was declared in 63 % of initial CRS. Reassessment (CT/MRI) before second-look was highly predictive of intraoperative and histological presence of CRPM, but intraoperative CRPM detection occurred in 61 % (CT-negative) and 81 % (MRI-negative) with histological confirmation in 53 % and 42 %. During second-look surgery, CRPM was observed in 88 % of cases (median PCI score:6) and 11.3 % were unresectable. Median overall survival (OS) was 43 months with 1- and 5-year OS of 95 % and 34.3 %, respectively. Prognostic factors of lower OS included poorly cohesive histology, emergency surgery and incomplete cytoreduction during first surgery in non-expert centers.
CONCLUSIONS: In patients with CRPM initially managed in non-expert centers, expert-center reassessment, including consideration of second-look surgery, identifies persistent or recurrent peritoneal disease in a substantial proportion of patients, even in the absence of radiological evidence. These findings support the importance of early referral to expert centers for comprehensive evaluation and multidisciplinary decision-making. The impact of second-look strategies on survival outcomes warrants further prospective investigation.