Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: higher complication rate for oxaliplatin compared to Mitomycin C.
BACKGROUND
Peritoneal carcinomatosis (PC) from colo-rectal cancer carries a very poor prognosis with a mean and median overall survival times of 6.9 and 5.2 months. It has been proved that a locoregional therapeutic approach of this disease with cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) improved survival of these patients. However, this combined treatment presents a high complication rate.


METHODS
21 patients with PC of colorectal origin underwent complete cytoreduction followed by HIPEC using Mitomycin-C (13 patients) or oxaliplatin (8 patients) and the open coliseum technique. For each case the medical datas were retrospectively analysed to determine feasibility, morbidity, mortality, survival time and prognostic factors.


RESULTS
All patients presented a Sugarbaker's Peritoneal Cancer index inferior to 15. The mean operating time was 453 minutes. After a median follow-up of 24.9 months, actuarial disease-free survival was 36.6% at 5 years. The median survival time was 34 months. The morbidity rate was 33.3% with a significant higher complication rate in the oxaliplatin group (5/8) than in the Mytomycin-C (MMC) group (2/13). One patient (4.7%) died two months after treatment with MMC (endocarditis).


CONCLUSIONS
This series confirm positive impact of cytoreduction and HIPEC on PC. We obtained a moderated complications rate thanks to a high degree of selection of the patient. Oxaliplatin scheme is responsible of a higher morbidity than in MMC group. Phase III trial comparing these two drugs is needed.
Rouers
A
A
Dpt of Abdominal Surgery, CHU Sart Tilman B35, B4000 Liège, Belgium. a.rouers@skynet.be
Laurent
S
S
Detroz
B
B
Meurisse
M
M
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009944:Organoplatinum Compounds / Q000008:administration & dosage*; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016685:Mitomycin