Furthermore, there are two large multi-centre studies that have included hepatic metastases in their multivariable analyses (without any specific clinical or survival data). Both studies come from France and one shows that concomitant HM is a definite negative prognostic factor for overall survival while the other one shows no statistical difference in survival (7,8). One review article from 2009 concluded that while there may be some evidence of a survival

benefit, the evidence at hand is too scarce to make any general recommendations (9). Further studies are Inhibitors,research,lifescience,medical needed to elucidate the value of treating colorectal PM and HM aggressively with surgery. The aim of this study was to compare the treatment of colorectal PM with CRS and IPC vs. the treatment Inhibitors,research,lifescience,medical of colorectal PM and HM with CRS, IPC, and hepatic resections. The overall survival, disease

free survival, morbidity, and mortality were the parameters of main interest. Patients and methods Patient selection From the Uppsala University Hospital prospective database of colorectal PM, all patients undergoing simultaneous PM and HM treatments were extracted and included in the study’s PM/HM group. A second control group (PM only) was selected without knowledge of survival by matching 1:2 for the following Inhibitors,research,lifescience,medical parameters: HIPEC or sequential postoperative intraperitoneal chemotherapy (SPIC), R1 or R2 resections, and peritoneal cancer index (PCI) (same PCI ±1 point). If more than 2 patients were eligible for matching than the two patients with the closest treatment Inhibitors,research,lifescience,medical date to the PM/HM patient were chosen. Clinicopathological variables were collected retrospectively from the patient charts as well as surgical variables from the operation

notes. The 90-day morbidity and in-hospital treatment-related morbidity was reported Inhibitors,research,lifescience,medical according to Common Terminology Criteria for Adverse Events v3.0 and only grades III to V adverse events were registered. The study was approved by the Uppsala Regional Ethics board. Surgical methods The CRS was performed as previously described with different organ LY2835219 solubility dmso resections where needed combined with peritonectomy procedures of affected peritoneum (10). The aim was to reach macroscopic complete resection of the disease which was designated as an R1 resection. Where there was macroscopic disease remaining, the patients was designated an R2 resection. The others PCI is a semi-quantitative score that combines tumour nodule size with distribution according to 13 abdominal regions and is determined during the opening phase of surgery. Each region can have a score from zero to three, depending on nodule size; thus, the top score with maximal tumour size and distribution is 39 (11). The prior surgical score (PSS) is a measure of the extent of surgical trauma prior to the CRS and IPC treatment (11).