Annals of surgical oncology · 2026
Role of Palliative Cytoreductive Surgery for Patients with Incompletely Resectable Peritoneal Carcinomatosis from Lower Gastrointestinal Cancers.
СтатьяНазвание и аннотация: Перевод в очереди
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Neilson Taylor, Lie Jessica J, Seldomridge Ashlee, Morgan Ryan B, Kearse LaDonna, Song Yun, Mansfield Paul F, Hodge Caitlin, Willis Jason, Shen John Paul, Hu Ian, Feldman Jarett, Morris Van, White Michael G, Fournier Keith F, Helmink Beth A, Marincola Smith Paula
Аннотация
INTRODUCTION: Peritoneal carcinomatosis from lower gastrointestinal malignancies causes debilitating intra-abdominal complications, including bowel obstruction, ascites, and biliary/ureteral obstruction. Guidelines addressing palliative cytoreductive surgery (CRS) in patient's ineligible for curative resection remain limited.
METHODS: Patients who underwent CRS for appendiceal cancer (AC)- or colorectal cancer (CRC)-related carcinomatosis not amenable to complete cytoreduction at one referral center (2004-2025) were retrospectively reviewed. Tumor grade was dichotomized into low- (well- and well-to-moderately differentiated ACs) versus high-grade (moderately or poorly differentiated/signet ring ACs, all CRCs). Descriptive statistics summarize patient demographics. Carcinomatosis-related complication-free (CRCFS), obstruction-free (OFS), ascites-free (AFS), and overall survival (OS) were estimated by using the Kaplan-Meier method.
RESULTS: A total of 131 patients underwent palliative CRS. The most common reasons for incomplete cytoreduction were high tumor burden/multiple unresectable areas 62 (47%), portal 20 (15%), small bowel 19 (14%), or pelvic 17 (13%) disease. Common palliative procedures included omentectomy 86 (66%), hyperthermic intraperitoneal chemotherapy 63 (48%), bowel resection 63 (48%), gastrostomy tube/gastropexy 60 (46%), and intestinal bypass 27 (20%). Twenty-two (17%) patients had major complications, and median length of stay was 11 days (IQR 9-14). Median CRCFS, OFS, AFS, and OS were 11, 16, 62, and 13 months for high-grade versus 36, NR, NR, and 37 months for low-grade tumors. The strongest predictor of shortened CRCFS, OFS, AFS, and OS was high-grade histology.
CONCLUSIONS: Palliative CRS for incompletely resectable carcinomatosis is associated with prolonged OFS and AFS for patients with low-grade histology. Palliative surgical intervention should be considered in carefully selected patients.
METHODS: Patients who underwent CRS for appendiceal cancer (AC)- or colorectal cancer (CRC)-related carcinomatosis not amenable to complete cytoreduction at one referral center (2004-2025) were retrospectively reviewed. Tumor grade was dichotomized into low- (well- and well-to-moderately differentiated ACs) versus high-grade (moderately or poorly differentiated/signet ring ACs, all CRCs). Descriptive statistics summarize patient demographics. Carcinomatosis-related complication-free (CRCFS), obstruction-free (OFS), ascites-free (AFS), and overall survival (OS) were estimated by using the Kaplan-Meier method.
RESULTS: A total of 131 patients underwent palliative CRS. The most common reasons for incomplete cytoreduction were high tumor burden/multiple unresectable areas 62 (47%), portal 20 (15%), small bowel 19 (14%), or pelvic 17 (13%) disease. Common palliative procedures included omentectomy 86 (66%), hyperthermic intraperitoneal chemotherapy 63 (48%), bowel resection 63 (48%), gastrostomy tube/gastropexy 60 (46%), and intestinal bypass 27 (20%). Twenty-two (17%) patients had major complications, and median length of stay was 11 days (IQR 9-14). Median CRCFS, OFS, AFS, and OS were 11, 16, 62, and 13 months for high-grade versus 36, NR, NR, and 37 months for low-grade tumors. The strongest predictor of shortened CRCFS, OFS, AFS, and OS was high-grade histology.
CONCLUSIONS: Palliative CRS for incompletely resectable carcinomatosis is associated with prolonged OFS and AFS for patients with low-grade histology. Palliative surgical intervention should be considered in carefully selected patients.