Factors Associated with Peritoneal Recurrence in Patients with Colorectal Cancer having Minimal Serosal Involvement: A Pooled Analysis of Randomized Comparative Study

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Abstract Background: Peritoneal carcinomatosis (PC) is an uncommon recurrence pattern, which accounts for 3%–6% of local colon cancer and 25% of colorectal cancer recurrences. This study aimed to determine the incidence of PC and investigate its related risk factors after a colectomy. Methods: This prospective, interventional, randomized, comparative, single-center study recruited adult patients who are scheduled to undergo colectomy. Here, we pooled the data of all patients to assess the risk factors for PC recurrence for 18 months of follow-up. Results: The median peritoneal recurrence-free survival (PRFS) was 16 months, and the cumulative 1-year and 18-month PRFS was 52.4% and 30.6%, respectively. No statistically significant associations were found between the PRFS and any of the preoperative characteristics of patients. The nodal stage had a statistically significant effect on developing peritoneal recurrence. The higher the tumor nodal burden, the higher the risk for developing future PC compared to lower nodal stages (p = 0.039). Additionally, elevated tumor markers during the follow-up period were highly predictive of peritoneal recurrence (p = 0.002). The cumulative 18-month PRFS was 50% for patients who underwent hyperthermic intraperitoneal chemotherapy compared to 12.1% in the standard treatment arm group (p= 0.250). Conclusions: This study revealed a high incidence of recurrent PC in high-risk patients after colectomy and the association of lymph node involvement with a higher risk of recurrent PC. However, further studies are required to investigate the prognostic risk factors in a larger sample and different patient groups.

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