Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2020; 12(8): 903-917
Published online Aug 15, 2020. doi: 10.4251/wjgo.v12.i8.903
Comparison of hyperthermic intraperitoneal chemotherapy regimens for treatment of peritoneal-metastasized colorectal cancer
Julia Spiegelberg, Hannes Neeff, Philipp Holzner, Mira Runkel, Stefan Fichtner-Feigl, Torben Glatz
Julia Spiegelberg, Hannes Neeff, Philipp Holzner, Mira Runkel, Stefan Fichtner-Feigl, Torben Glatz, Department of General and Visceral Surgery, Medical Center – University of Freiburg, Freiburg 79106, Germany
Torben Glatz, Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Herne 44625, Germany
Author contributions: All authors solely contributed to the preparation of this manuscript.
Institutional review board statement: The study was approved by the Medical Ethics Committee of the University of Freiburg (EK-FR 4/20).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at torben.glatz@uniklinik-freiburg.de.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Torben Glatz, MD, Surgeon, Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, Herne 44625, Germany. torben.glatz@uniklinik-freiburg.de
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: February 20, 2020
Revised: May 29, 2020
Accepted: June 14, 2020
Article in press: June 14, 2020
Published online: August 15, 2020
Abstract
BACKGROUND

Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) improves patient survival in colorectal cancer (CRC) with peritoneal carcinomatosis (PC). Commonly used cytotoxic agents include mitomycin C (MMC) and oxaliplatin. Studies have reported varying results, and the evidence for the choice of the HIPEC agent and uniform procedure protocols is limited.

AIM

To evaluate therapeutic benefits and complications of CRS + MMC vs oxaliplatin HIPEC in patients with peritoneal metastasized CRC as well as prognostic factors.

METHODS

One hundred and two consecutive patients who had undergone CRS and HIPEC for CRC PC between 2007 and 2019 at the Medical Center of the University Freiburg regarding interdisciplinary cancer conference decision were retrospectively analysed. Oxaliplatin and MMC were used in 68 and 34 patients, respectively. Each patient’s demographics and tumour characteristics, operative details, postoperative complications and survival were noted. Complications were stratified and graded using Clavien/Dindo analysis. Prognostic outcome factors were identified using univariate and multivariate analysis of survival.

RESULTS

The two groups did not differ significantly regarding baseline characteristics. We found no difference in median overall survival between MMC and oxaliplatin HIPEC. Regarding postoperative complications, patients treated with oxaliplatin HIPEC suffered increased complications (66.2% vs 35.3%; P = 0.003), particularly intestinal atony, intraabdominal infections and urinary tract infection, and had a prolonged intensive care unit stay compared to the MMC group (7.2 d vs 4.4 d; P = 0.035). Regarding univariate analysis of survival, we found primary tumour factors, nodal positivity and resection margins to be of prognostic value as well as peritoneal cancer index (PCI)-score and the completeness of cytoreduction regarding peritoneal carcinomatosis. Multivariate analysis of survival confirmed primary distant metastasis and primary tumour resection status to have a significant impact on survival and likewise peritoneal cancer index-scoring regarding peritoneal carcinomatosis.

CONCLUSION

In this single-institution retrospective review of patients undergoing CRS with either oxaliplatin or MMC HIPEC, overall survival was not different, though oxaliplatin was associated with a higher postoperative complication rate, indicating treatment favourably with MMC. Further studies comparing HIPEC regimens would improve evidence-based decision-making.

Keywords: Colorectal cancer, Peritoneal carcinomatosis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Chemotherapy, Mitomycin

Core tip: We evaluated the therapeutic efficiency of cytoreductive surgery in combination with two different hyperthermic intraperitoneal chemotherapy (HIPEC) regimens, comparing mitomycin C HIPEC vs oxaliplatin HIPEC. We therefore retrospectively evaluated 102 patients undergoing cytoreductive surgery and HIPEC and statistically analysed demographics, perioperative complication and survival outcome. We found no difference in median overall survival between mitomycin C and oxaliplatin HIPEC. Regarding postoperative complications, patients treated with oxaliplatin HIPEC suffered an increased complication rate. Regarding multivariate analysis of survival, primary distant metastasis and primary tumour resection seem to have a significant impact on survival and likewise peritoneal cancer index-scoring regarding peritoneal carcinomatosis. Further prospective studies comparing HIPEC regimens would improve therapeutic decision-making.