The Negative Impact of a Non-Therapeutic Laparotomy in Patients With Inoperable Colorectal Peritoneal Metastases.

BACKGROUND

The peritoneum is the third most prevalent location for metastases of colorectal cancer. In patients with resectable disease, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the preferred treatment in the Netherlands, achieving median overall survival (OS) of 36-42 months. However, during explorative laparotomy, CRS-HIPEC may appear unfeasible. Evidence on how such non-therapeutic laparotomies affect prognosis is limited.

METHODS

This retrospective cohort study included all non-therapeutic laparotomies performed between 01 and 01-2010 and 01-01-2022 in two Dutch tertiary HIPEC-centers. Patient, tumor and treatment characteristics, postoperative morbidity, and survival outcomes were analyzed and compared to existing literature.

RESULTS

In total, 108 patients underwent a non-therapeutic laparotomy (discontinued CRS-HIPEC). The main reason was that peritoneal disease was too extensive (56%). Severe postoperative complications (Clavien-Dindo ≥ 3) occurred in 9%. Following a non-therapeutic procedure, 55% of patients received tumor-directed palliative treatment. Median OS of the entire cohort was 6.5 months (95% CI 5.1-8.0). Palliative systemic therapy was the only factor significantly associated with improved OS (12.6 vs. 2.9 months, p < 0.001).

CONCLUSIONS

Non-therapeutic laparotomies are associated with decreased survival in patients with extensive peritoneal metastases. Reducing their occurrence is essential. Advances in diagnostic modalities, including MRI, FAPI-PET, artificial intelligence, and developments in bidirectional treatments, may improve preoperative selection and offer alternative therapeutic options. Further research is required.