Mitomycin-C versus oxaliplatin during cytoreductive surgery and HIPEC for peritoneal metastases secondary to colorectal carcinoma: a retrospective analysis.

PURPOSE: Combining cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer, however the optimal choice of the HIPEC chemotherapy is still under debate. The present study compares the clinical outcome in patients with peritoneal metastases treated with CRS and HIPEC using Mitomycin - C versus Oxaliplatin. METHODS: We retrospectively analyzed patients that underwent CRS and HIPEC for recurrent colorectal cancer with peritoneal metastases. Patient characteristics, procedure details, and clinical outcomes were evaluated. RESULTS: 114 consecutive patients were included in the analysis (62 males - 52 females, mean age 58,3 years). The mean intraoperative PCI-score was 15.3 (range: 3 - 36). The mean follow-up period was 28.2 months. Patients receiving MMC - based HIPEC had significantly higher mean overall survival compared to oxaliplatin (54 versus 26 months), translated to a hazard ratio of 0.26 (95% CI 0.128 - 0.529, p<0.01). The HIPEC regimen as well as the completeness of cytoreduction were the only independent prognostic factors of survival in our sample. CONCLUSIONS: Our results imply that the use of MMC offers a survival advantage over oxaliplatin when used for HIPEC in CRC PC. A randomised trial comparing oxaliplatin and MMC would enhance decision-making in such patients.

Is there a role of repeat cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with relapse from peritoneal metastatic disease? A survival analysis.

PURPOSE: We aimed to evaluate the role of repeat cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of patients with recurrent peritoneal metastatic disease (PM) with special consideration to perioperative outcomes and long-term survival outcomes. METHODS: Patients with recurrent PM who underwent CRS and HIPEC for the management of the disease for an interval of 15 years were retrospectively analyzed. Primary tumor location, peritoneal cancer index, completeness of cytoreduction (CC), morbidity, mortality, overall survival (OS), and progression-free survival (PFS) after the 1st and 2nd HIPEC were assessed. RESULTS: A total of 48 patients who underwent repeat CRS and HIPEC for the management of disease relapse were included in this study. The median OS from initial diagnosis was 37 months (range: 12-128) while the PFS after the second CRS and HIPEC was 12 months (range: 0-36). A total of 30 complications were recorded among which 18.8% were classified as major. CC-0 resection was a significant indicator of survival either on univariate or on multivariate analysis. CONCLUSIONS: The outcomes of the present study indicate the feasibility of repeat CRS and HIPEC procedures in patients with recurrent peritoneal metastasis with significant morbidity, acceptable mortality and long-term survival outcomes which were highly associated with CC status.