538P - Combined hepatectomy with complete cytoreduction (CCS) and hyperthermic intraperitoneal chemotherapy (HIPEC) vs. HIPEC alone for metastatic colorectal cancer: A systematic review and meta-analysis

Background

CCS and HIPEC are used as therapeutic approaches for metastatic colorectal cancer patients. However, the combination of hepatectomy with CCS and HIPEC in patients with liver metastasis is emerging as a controversial topic in the medical field.

Methods

We searched PubMed, Embase, and Cochrane Central for studies comparing combined hepatectomy with CRS and HIPEC for metastatic liver and peritoneal tumors with HIPEC alone for peritoneal metastasis in patients with primary colorectal cancer. Statistical analysis was performed using R statistical software 4.3.2. We considered as significant p values < 0.05.

Results

We included 959 patients from 9 retrospective studies. The mean age in the combined group was 57.42 and in the group with HIPEC alone, it was 55.72 years. The mean peritoneal carcinomatosis index was 12.01 in the combined group and 9.29 in the control group. The mean overall survival (OS) was 27.99 months for the intervention and 36.89 for the control, and the mean disease-free survival (DFS) rate was 10.34 and 13.27 months, respectively. The mean follow-up in the studies was 43.35 months. The 5-year OS was not significantly different between the groups (HR 1.37; 95% CI 0.99–1.89; p = 0.06). Additionally, the intervention group showed a significantly higher length of ICU stay (MD 0.72 days; 95% CI 0.20–1.23; p < 0.01) and length of hospital stay (MD 6.71 days; 95% CI 3.24–10.17; p < 0.01), with an already expected increase in operative time (MD 53.44 minutes; 95% CI -3.91–110.79; p = 0.07). The intervention group also showed higher severe morbidity (Clavien-Dindo >3) (33.33% vs. 18.72%; OR 2.51; 95% CI 1.50–4.18; p < 0.001). The recurrence rate was higher in the intervention group, even though it was not statistically significant (62.63% vs. 55.16%; OR 1.09; 95% CI 0.55–2.16; p = 0.803).

Conclusions

Our analysis showed that combining CRS and HIPEC with hepatectomy leads to a higher morbidity, and recurrence rate, with a lower mean OS and DFS. Therefore, combining CCS and HIPEC with hepatectomy should be avoided.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.