ASO Author Reflections: Centralization of Cytoreductive Surgery Alone in Colorectal Peritoneal Metastases Patients: Optimizing Treatment Pathways

Excerpt

Several studies have demonstrated the efficacy of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in selected patients with peritoneal surface malignancies (PSMs), improving patient prognosis. Centralization has been shown to be beneficial in improving oncological outcomes across various types of cancers. We have previously published a 10-year French national study on the importance of centralizing PSM surgeries, with a reduction in 90-day postoperative mortality (POM) from 3.2 to 1.9% and a twofold decrease in failure to rescue (FTR) when the CRS/HIPEC procedures were performed in a high-volume (HV) center (>30 CRS/HIPEC procedures per year).¹ A recent Dutch national study evaluated practice variations among patients with peritoneal metastases of colorectal origin (CRPM) undergoing CRS and HIPEC, and showed that harmonizing practices across centers could enhance patients’ chances of treatment and, subsequently, survival.² However, the results of the French randomized PRODIGE 7 trial showed no benefit from adding oxaliplatin/HIPEC to CRS but a remarkable overall survival (OS) of 41 months in both groups.³ Since its presentation at the 2018 American Society of Clinical Oncology, members of the Peritoneal Surface Oncology Group International (PSOGI) have expressed concerns regarding the potential impact of the PRODIGE 7 trial, leading to a decrease in the number of patients referred to expert centers in favor of CRS alone performed in non-expert centers.⁴ In view of these results, our study was conducted to evaluate perioperative outcomes in relation to hospital volume and the effect of PRODIGE 7 on French practice in CRPM patients. …