Long-term survival of a patient with colorectal cancer with peritoneal carcinomatosis and low completeness of cytoreduction score: A case report

Abstract

BACKGROUND

Peritoneal metastasis occurs in about 20% of patients with colorectal cancer (CRC) and is associated with a 5-year survival rate of only 6%. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients. Achieving complete cytoreduction, indicated by a low completeness of cytoreduction (CCR) score, is a key factor in extending survival. Here, we present a case in which multimodal therapy yielded long-term survival in a patient, even though she had a CCR score of 3.

CASE SUMMARY

A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention. Cytoreductive surgery was not completed due to the extent of the disease (CCR score: 3). The patient underwent palliative omentectomy, followed by hyperthermic intraperitoneal chemotherapy with mitomycin C, and early postoperative intraperitoneal chemotherapy. She subsequently received systemic chemotherapy, which was terminated after 19 cycles and two dose reductions due to side effects. She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.

CONCLUSION

Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease, even with high CCR scores.

Keywords: Colorectal cancer; Peritoneal carcinomatosis; Cytoreduction score; Long-term survival; Multimodal treatment; Case report

Core Tip: Long-term survival of patients with a completeness of cytoreduction score of 3 is rarely observed; nonetheless, a favorable outcome was attained in this case by using tailored, multimodal treatment. Despite a substantial residual tumor burden, the 61-year-old female patient survived at least 6 years, suggesting the benefit of aggressive, multimodal treatment even in advanced disease. Despite the challenges in preoperatively identifying patients suited for cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, administering the most effective therapy that the patient can tolerate is likely to produce positive outcomes.