This research looked at whether giving a specific type of chemotherapy directly into the abdomen during or after curative surgery for colorectal cancer helps patients. The method, called prophylactic intraperitoneal chemotherapy (PIC), uses platinum-based drugs. The goal was to see if it could prevent the cancer from returning in the abdominal lining and improve survival. The analysis combined data from multiple studies involving over 1,200 adults who had surgery with the goal of curing their colorectal cancer. The main finding was that this approach was linked to a significant improvement in disease-free survival, meaning patients stayed cancer-free for longer. Importantly, the analysis did not find an increase in serious side effects or major complications from adding this treatment. However, the results for overall survival—how long patients lived—were not statistically significant, meaning the benefit wasn't clear. The data on preventing cancer recurrence in the abdomen was also mixed and uncertain. This was a review of existing studies, not a new clinical trial. The findings suggest this chemotherapy method shows promise for keeping cancer from coming back, but it hasn't yet been proven to help people live longer. More large, well-designed studies are needed to confirm these results and figure out the best way to use this treatment.
Platinum-based intraperitoneal chemotherapy improves disease-free survival after curative CRC resectionStudy reviews chemotherapy method for colorectal cancer after surgery
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Key Takeaway
Consider platinum-based intraperitoneal chemotherapy may improve DFS after CRC resection, but OS benefit remains unconfirmed.
This systematic review and meta-analysis examined platinum-based prophylactic intraperitoneal chemotherapy (PIC) administered during or after curative colorectal cancer resection in 1,264 adults, compared to surgery alone or standard systemic therapy. The analysis focused on overall survival, disease-free survival, and peritoneal recurrence outcomes.
For disease-free survival, PIC showed significant improvement with a hazard ratio of 0.57 (95% CI 0.42-0.78, p=0.0004). Overall survival trended toward benefit but was not statistically significant (HR 0.87, 95% CI 0.69-1.12, p=0.28). Peritoneal recurrence was reduced but showed substantial heterogeneity (RR 0.69, 95% CI 0.29-1.63, p=0.40, I²=85%).
Safety analysis found no significant increase in grade 3-4 adverse events (RR 1.26, 95% CI 0.97-1.64, p=0.08) or major complications. Key limitations include high heterogeneity in peritoneal recurrence results and the need for larger randomized controlled trials with longer follow-up to confirm potential survival benefits and determine optimal protocols. This evidence suggests platinum-based PIC may enhance disease-free survival without increasing adverse events, but clinical application should await more definitive trial data.
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View Original Abstract ↓
BACKGROUND: Peritoneal recurrence is a significant concern after curative resection of colorectal cancer (CRC), with systemic chemotherapy providing limited prevention. Prophylactic intraperitoneal chemotherapy (PIC) using platinum-based agents offers a potential strategy to reduce recurrence and improve survival.
OBJECTIVE: Our objective was to assess the effectiveness of platinum-based PIC in reducing peritoneal recurrence and enhancing survival outcomes when administered during or after curative CRC resection versus surgery alone or standard systemic therapy.
METHODS: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Databases were searched from January 2015 to September 2025 for randomized and comparative studies of adults receiving curative CRC resection with platinum-based PIC versus controls. Primary outcomes were overall survival (OS), disease-free survival (DFS), and peritoneal recurrence. Secondary outcomes were grade 3-4 adverse events and major complications. Random-effects meta-analyses in R used hazard ratios (HRs) for time-to-event outcomes and risk ratios (RRs) for binary outcomes; heterogeneity was assessed via I.
RESULTS: In total, 16 studies were included in the qualitative synthesis and seven (three randomized controlled trials, four cohorts; n=1264) in the meta-analysis. Platinum-based PIC improved DFS (HR 0.57; 95% confidence interval [CI] 0.42-0.78, p=0.0004, I=0%) and trended toward an OS benefit (HR 0.87; 95% CI 0.69-1.12, p=0.28, I=0%). Peritoneal recurrence was reduced but heterogeneous (RR 0.69; 95% CI 0.29-1.63, p=0.40, I=85%). No increases were observed in grade 3-4 events (RR 1.26; 95% CI 0.97-1.64, p=0.08, I=0%) or complications (RR 1.02; 95% CI 0.74-1.39, p=0.91, I=39%).
CONCLUSIONS: Platinum-based PIC appears to enhance DFS without increasing adverse events or complications. Larger randomized controlled trials with longer follow-up are needed to confirm potential survival benefits and determine optimal protocols.
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