Prophylactic Intraperitoneal Chemotherapy with Platinum Agents Following Curative Resection for Colorectal Cancer: A...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Peritoneal recurrence is a major challenge in colorectal cancer (CRC) management post-resection.
• Systemic chemotherapy offers limited efficacy in preventing peritoneal recurrence.
• Prophylactic intraperitoneal chemotherapy (PIC) with platinum-based agents presents a potential strategy to mitigate recurrence and improve survival.

Purpose of the Study:

• To evaluate the effectiveness of platinum-based PIC in reducing peritoneal recurrence and improving survival outcomes.
• To compare PIC during or after curative CRC resection against surgery alone or standard systemic therapy.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
• Searched databases for randomized and comparative studies of adults undergoing curative CRC resection with platinum-based PIC.
• Primary outcomes included overall survival (OS), disease-free survival (DFS), and peritoneal recurrence; secondary outcomes were grade 3-4 adverse events and complications.

Main Results:

• Meta-analysis of seven studies (n=1264) revealed significant improvement in DFS with platinum-based PIC (HR 0.57; p=0.0004).
• A trend towards improved OS was observed (HR 0.87; p=0.28), with reduced peritoneal recurrence (RR 0.69; p=0.40) but high heterogeneity (I²=85%).
• No significant increase in grade 3-4 adverse events (RR 1.26; p=0.08) or major complications (RR 1.02; p=0.91) was noted.

Conclusions:

• Platinum-based PIC enhances DFS in CRC patients post-resection without escalating adverse events or complications.
• Further large-scale randomized controlled trials with extended follow-up are necessary to confirm survival benefits and optimize PIC protocols.