| Objective:Most colorectal cancer (CRC) patients have reached advanced stage when first diagnosed. An important reason of treatment failure in advanced CRC is implantation and dissemination within the peritoneal cavity. The treatment approach of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) which gradually develops in recent decades, and showed promising efficacy in early clinical studies, is becoming a new curative treatment with extreme potentials. The purpose of this study is to investigate the efficacy and security of CRS/IPC in CRC, especially advanced CRC, and to compare the difference of efficacy between the two different types of IPC:Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and early postoperatively intraperitoneal chemotherapy (EPIC). The preliminary assessment of CRS/HIPEC treatment security in our department is aimed as well.Material and Methods:Electronic searches were performed using biomedical information databases domestic and international to collect studies of randomized control trial of surgery+IPC vs. Standard treatment in patient with CRC. Data was subgrouped into HIPEC and EPIC to perform systematic review with meta-analysis study. Details of complications and death information were listed and calculated to further investigate the mortality distribution. Postoperative complication information of patients treated with CRS/HIPEC is our department by now is last reported to evaluate the security of the treatment in our hospital.Results:Twelve domestic and worldwide prospective RCTs has been included, with1055patient:544into IPC arm and511into standard treatment arm. HIPEC subgroup contains10studies with753patients,395into HIPEC arm and358into standard treatment arm. The other two studies goes to EPIC subgroup with302patients,149into EPIC arm and153into standard treatment arm. The two different treatment approach didn’t present statistic difference in1-year survival rate (HR=0.88, P=0.58), but surgery+IPC improves:3and5-year survival rate (HR=0.74,0.66; P=0.01,0.0002respectively), and reduces3and5-year recurrence (HR=0.36,0.59; P=0.003,0.005respectively). The difference is more prominent in HIPEC subgroup, with3and5-year survival rate HR of0.65,0.61respectively (P=0.002,0.0001respectively), and3and5-year recurrence HR of0.36,0.31respectively (P=0.003,0.0005respectively); EPIC subgroup alone didn’t bring out statistic differences in3,5-year survival or5-year recurrence; Subgroup difference occurred in1-year,3-year survival and5-year recurrence study statistically. There was also slight statistic difference between subgroups in5-year survival. Probably due to calculating and analyzing methodology, and the medical advancement, overall complications of IPC treatment are commensurate with standard treatment (OR=1.15, P=0.39), however EPIC treatment revealed obviously elevated complications (OR=2.06, P=0.02). The most common complication is myelosuppression, followed by ileus and anastomotic fistula. Overall postoperative mortality is1.99%, deaths are usually caused by aplasia, uncontrollable abdominal sepsis, pulmonary embolism and cardiac arrhythmia. Five advanced CRC patients were treated with CRS/HIPEC in our department by now, no death occurred post-operatively. With one patient developing intestinal fistula, the complication incidence is20%.Conclusions:The current evidence suggests that IPC has the tendency of improving long-term survival in advanced CRC patients, and of reducing long-term recurrence. HIPEC shows better efficacy than EPIC, which suggests that heat might also has therapeutical effect; Complications and Mortality of CRS/IPC might still be higher than standard treatment, but is acceptable; Clinical trial of CRS/HIPEC treatment in out department seems to be of relatively high security determined by now. |
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