Optimal duration of neoadjuvant chemotherapy prior to CRS±HIPEC for colorectal cancer: An assessment of survival and postoperative outcomes

Abstract

Background

Cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC) represents a viable therapy for select patients with colorectal cancer (CRC) peritoneal metastases. Given recurrence rates, challenges returning to oncologic treatment postoperatively, and desire to assess tumor biology, neoadjuvant chemotherapy (NAC) is common. Evidence-based guidance regarding NAC duration is limited.

Methods

A single institution database (2009–2024) of patients with CRC that underwent CRS±HIPEC was reviewed. Patients undergoing curative intent CRS±HIPEC with known NAC duration were stratified by NAC duration (0–3 vs >3 months). Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). Secondary outcome was clinically significant postoperative complications.

Results

From 2009–2024, 87 patients underwent curative intent CRS±HIPEC (>3 months NAC: 58 patients, 0–3 months NAC: 29 patients). Median peritoneal cancer index score was similar between cohorts (>3 months: 11 vs 0–3 months: 12; p = 0.98). RFS and OS were not statistically different based on NAC duration (RFS: >3 months: 8 months vs 0–3 months: 15 months, p = 0.28) (OS: >3 months: 26 months vs 0–3 months: 35 months; p = 0.33). > 3 months of NAC was associated with increased median length of stay (>3 months: 10 days vs 0–3 months: 8 days; p = 0.04). Even when controlling for other perioperative variables on multivariable analysis, > 3 months of NAC was associated with increased risk of clinically significant complications (HR 3.47, 95 % CI 1.11–10.88; p = 0.03).

Conclusion

Greater duration of NAC prior to CRS±HIPEC is not associated with improved RFS or OS, and, rather, is associated with higher complication rate and longer hospital stay.