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Introduction <p>Peritoneal carcinomatosis from lower gastrointestinal malignancies causes debilitating intra-abdominal complications, including bowel obstruction, ascites, and biliary/ureteral obstruction. Guidelines addressing palliative cytoreductive surgery (CRS) in patient’s ineligible for curative resection remain limited.</p> Methods <p>Patients who underwent CRS for appendiceal cancer (AC)- or colorectal cancer (CRC)-related carcinomatosis not amenable to complete cytoreduction at one referral center (2004–2025) were retrospectively reviewed. Tumor grade was dichotomized into low- (well- and well-to-moderately differentiated ACs) versus high-grade (moderately or poorly differentiated/signet ring ACs, all CRCs). Descriptive statistics summarize patient demographics. Carcinomatosis-related complication-free (CRCFS), obstruction-free (OFS), ascites-free (AFS), and overall survival (OS) were estimated by using the Kaplan-Meier method.</p> Results <p>A total of 131 patients underwent palliative CRS. The most common reasons for incomplete cytoreduction were high tumor burden/multiple unresectable areas 62 (47%), portal 20 (15%), small bowel 19 (14%), or pelvic 17 (13%) disease. Common palliative procedures included omentectomy 86 (66%), hyperthermic intraperitoneal chemotherapy 63 (48%), bowel resection 63 (48%), gastrostomy tube/gastropexy 60 (46%), and intestinal bypass 27 (20%). Twenty-two (17%) patients had major complications, and median length of stay was 11 days (IQR 9–14). Median CRCFS, OFS, AFS, and OS were 11, 16, 62, and 13 months for high-grade versus 36, NR, NR, and 37 months for low-grade tumors. The strongest predictor of shortened CRCFS, OFS, AFS, and OS was high-grade histology.</p> Conclusions <p>Palliative CRS for incompletely resectable carcinomatosis is associated with prolonged OFS and AFS for patients with low-grade histology. Palliative surgical intervention should be considered in carefully selected patients.</p>

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Role of Palliative Cytoreductive Surgery for Patients with Incompletely Resectable Peritoneal Carcinomatosis from Lower Gastrointestinal Cancers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月3日

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  • Taylor Neilson,
  • Jessica J. Lie,
  • Ashlee Seldomridge,
  • Ryan B. Morgan,
  • LaDonna Kearse,
  • Yun Song,
  • Paul F. Mansfield,
  • Caitlin Hodge,
  • Jason Willis,
  • John Paul Shen,
  • Ian Hu,
  • Jarett Feldman,
  • Van Morris,
  • Michael G. White,
  • Keith F. Fournier,
  • Beth A. Helmink,
  • Paula Marincola Smith

摘要

Introduction

Peritoneal carcinomatosis from lower gastrointestinal malignancies causes debilitating intra-abdominal complications, including bowel obstruction, ascites, and biliary/ureteral obstruction. Guidelines addressing palliative cytoreductive surgery (CRS) in patient’s ineligible for curative resection remain limited.

Methods

Patients who underwent CRS for appendiceal cancer (AC)- or colorectal cancer (CRC)-related carcinomatosis not amenable to complete cytoreduction at one referral center (2004–2025) were retrospectively reviewed. Tumor grade was dichotomized into low- (well- and well-to-moderately differentiated ACs) versus high-grade (moderately or poorly differentiated/signet ring ACs, all CRCs). Descriptive statistics summarize patient demographics. Carcinomatosis-related complication-free (CRCFS), obstruction-free (OFS), ascites-free (AFS), and overall survival (OS) were estimated by using the Kaplan-Meier method.

Results

A total of 131 patients underwent palliative CRS. The most common reasons for incomplete cytoreduction were high tumor burden/multiple unresectable areas 62 (47%), portal 20 (15%), small bowel 19 (14%), or pelvic 17 (13%) disease. Common palliative procedures included omentectomy 86 (66%), hyperthermic intraperitoneal chemotherapy 63 (48%), bowel resection 63 (48%), gastrostomy tube/gastropexy 60 (46%), and intestinal bypass 27 (20%). Twenty-two (17%) patients had major complications, and median length of stay was 11 days (IQR 9–14). Median CRCFS, OFS, AFS, and OS were 11, 16, 62, and 13 months for high-grade versus 36, NR, NR, and 37 months for low-grade tumors. The strongest predictor of shortened CRCFS, OFS, AFS, and OS was high-grade histology.

Conclusions

Palliative CRS for incompletely resectable carcinomatosis is associated with prolonged OFS and AFS for patients with low-grade histology. Palliative surgical intervention should be considered in carefully selected patients.