Unresectable peritoneal carcinomatosis from colorectal cancer: A single center experience

Background and objectives For unresectable peritoneal carcinomatosis (PC) median overall survival (OS) is 5-6 months. This article analyzes patients with PC from colorectal cancer (CRC) uneligible for debulking and hyperthermic intra-peritoneal chemotherapy, describing patient-and tumor-related factors possibly affecting survival. Patients and Methods From 2005 to 2009, 43 patients presented with unresectable PC from CRC: male/female ratio was 29/14, median age was 57.1 years (range 34.8-76.8). "Unresectability" was defined as: six to seven abdominal regions affected by PC, involvement of mesentery or small bowel in the PC, presence of liver metastases, retroperitoneal lymph nodes, vascular invasion, and/or neural invasion. Results Median time interval between diagnosis of the primary tumor and diagnosis of PC was 7.2 months (range 0.0-102.3). Primary tumors were right-sided in >50% and had been previously resected in >58%, 74.4% of PC occurred synchronously. Ascites was present at primary diagnosis in 37.2%. In 70% of cases, six to seven abdominal regions were affected and in 58.1% PC involved small bowel/mesentery. Systemic disease was present in 16.3%. In 18.6% of patients, a palliative diversion or ostomy was constructed. Median OS was 6.3 months (range 0.4-33.1). Thirty-one patients (72.1%) received palliative chemotherapy. Median OS was 9.3 months (range 0.9-33.1) with versus 3.1 months (range 0.4-6.5) without chemotherapy (P=0.000), with less favorable patient and tumor characteristics in the latter group. No other factors clearly influenced OS. Conclusion Palliative chemotherapy results in better OS, but this is probably attributable to factors influencing the patient's general condition.