Rectal cancer with macroscopic peritoneal involvement - Clinical challenges and consequences

Objective  In gastrointestinal cancer, serosal involvement indicates advanced disease. We looked at the possible role of clinical peritoneal involvement (CPI) in local recurrences (LRs) and the overall survival of patients with rectal cancer (RC). Method  Between 1993 and 2002, 6404 patients were diagnosed with RC. Based on macroscopic findings at surgery and corresponding histological findings, 166 patients (3%) had CPI. Surgery was stratified according to type and extent of operation: as resective or nonresective surgery and as curative (R0) or noncurative (R1 or R2) resection. Results  The presence of CPI was a negative factor for survival with a median of 15 months (95% CI, 12–19) in the presence of CPI compared with 65 months (95% CI, 61–70) without it (P < 0.001). In R0 resections, the median survival was 97 months (95% CI, 90–102) in patients without CPI compared with 48 months (95% CI, 22–74) in patients with CPI (P < 0.001). In R1 or R2 resections, the median survival was 16 months (95% CI, 15–17) in the absence of CPI and 9 months (95% CI, 8–10) in the presence of CPI. The LR rate in patients without CPI was 10.2% compared with 15.7% in patients with CPI (P = 0.022). Conclusions  Clinical peritoneal involvement is a significant detrimental prognostic factor for the LR of RC and survival in the absence of metastases. Observations from this large national cohort add to what is known about peritoneal involvement. Diagnosed CPI should be taken into consideration when adjuvant treatment strategies are addressed.