scholarly journals Morbidity associated with the use of oxaliplatin versus mitomycin C in hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal or appendiceal origin: a multi-institutional comparative study

2021 ◽  
Vol 64 (2) ◽  
Author(s):  
Ella Benzaquen, ◽  
Yifan Wang ◽  
Stephanie Wiseman ◽  
Velka Rosenfeld ◽  
Lucas Sideris ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Mitomycin C ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Hematologic Toxicity ◽  
Transfusion Rate ◽  
Perioperative Morbidity ◽  
Colorectal Origin ◽  
Toxicity Scores ◽  
Tumour Characteristics

Background: The raw costs of mitomycin C (MMC) and oxaliplatin for hyperthermic intraperitoneal chemotherapy (HIPEC) differ substantially. We sought to compare the morbidity and toxicity profiles associated with the use of oxaliplatin and MMC in patients undergoing cytoreductive surgery (CRS) and HIPEC for peritoneal carcinomatosis (PC) of colorectal or appendiceal origin, to evaluate whether the costeffectiveness of these 2 agents should dictate drug choice. Methods: We conducted a retrospective multi-institutional study of all patients with PC of colorectal or appendiceal origin treated with CRS-HIPEC using MMC or oxaliplatin from 2010 to 2015. Demographic, perioperative, morbidity, toxicity and cost data were compared between the 2 treatment groups and between cancer-origin subgroups. Results: Forty-two patients treated with MMC and 76 treated with oxaliplatin were included in the study. Baseline demographic and tumour characteristics were comparable in the 2 groups, except that the patients treated with MMC had higher Charlson Comorbidity Index scores. The MMC group had a higher rate of cancer of colorectal origin (76.2% v. 57.9%, p = 0.047) and longer operative times (553 v. 320 min, p < 0.001). In the subgroup of patients whose cancer was of colorectal origin, patients treated with MMC had a higher transfusion rate (50.0% v. 28.6%, p = 0.023) and lower postoperative baseline hemoglobin level (100 v. 119 g/L, p = 0.002) than those treated with oxaliplatin. There was no difference in hematologic toxicity scores after controlling for postoperative anemia. There was no difference in the rates of major complications and 90-day mortality. However, MMC was less costly than oxaliplatin ($724 v. $8928). Conclusion: MMC and oxaliplatin are both suitable agents for HIPEC and are associated with comparable morbidity and toxicity profiles, regardless of cancer origin. Thus, we propose that cost-effectiveness should ultimately dictate drug selection.

scholarly journals Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis

2020 ◽  
Vol 36 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Seung Jae Roh ◽  
Sung Chan Park ◽  
Jaehee Choi ◽  
Joon Sang Lee ◽  
Dong Woon Lee ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Mitomycin C ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Complication Rate ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Early Period ◽  
Disease Free Survival ◽  
Late Complications ◽  
The Mean

Purpose: This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer.Methods: A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC.Results: Median disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality.Conclusion: Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

scholarly journals RESULTS OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY AND CYTOREDUCTIVE SURGERY FOR PERITONEAL CARCINOMATOSIS OF COLORECTAL ORIGIN

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
M Merayo Alvarez ◽  
E Turienzo Santos ◽  
M García Munar ◽  
I Cifrián Canales ◽  
J L Rodicio Miravalles ◽  
...  
Keyword(s):  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Descriptive Analysis ◽  
Disease Free Interval ◽  
Free Interval ◽  
Colorectal Origin ◽  
Disease Free

Abstract INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is supported by clinical practice and published series as a fundamental treatment for increasing survival of selected patients with colorectal peritoneal carcinomatosis. The results were evaluated since having implemented a peritoneal oncological surgery program five years ago. MATERIAL AND METHODS Descriptive analysis was conducted to patients who had been diagnosed with peritoneal carcinomatosis from May 2014 to December 2020. 36 out of 100 patients who had undergone surgery were included in the CRS and HIPEC assessment and 6 patients without HIPEC, were excluded. RESULTS The mean preoperative PCI was 7.81±6.61 accomplishing complete cytoreduction CC 0-CC-1 in the 36 cases. An average of 1.86±1.22 peritonectomies were performed. Among procedures, complete pelviperitonectomy (11 patients) and liver metastasis resection (6 patients) should be noticed. Complications were presented in 16 patients (8 patients over Clavien Dindo&gt;III) and 6 required reinterventions due to hematoma (2) or anastomotic leak (2) mostly. The 4-year overall survival is 76.2% and the disease-free interval is 34 months within an average follow-up of 23 months. CONCLUSIONS The overall survival and disease-free interval rates are above the standards. Currently, peritoneal carcinomatosis might be considered a curative disease. The multidisciplinary assessment allows selecting patients who will benefit from surgery.

Bidirectional intraperitoneal chemotherapy with oxaliplatin in the context of CRS and HIPEC in patients with peritoneal carcinomatosis.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 568-568
Author(s):  
G. Glockzin ◽  
H. J. Schlitt ◽  
P. Piso
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Mitomycin C ◽  
Intraperitoneal Chemotherapy ◽  
Operating Time ◽  
Matched Pair ◽  
Chemotherapeutic Regimen ◽  
Perioperative Morbidity ◽  
Crs And Hipec ◽  
The Mean ◽  
Matching Criteria

568 Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide a promising therapeutic option for selected patients with peritoneal carcinomatosis. The use of oxaliplatin as an intraperitoneal cytostatic agent seems to further improve the efficacy of the combined treatment concept. Nevertheless, additional toxicity in comparison to mitomycin C and/or doxorubicin might be exspected. Methods: Between 02/2008 and 08/2010 40 patients underwent CRS and HIPEC with oxaliplatin at a concentration of 300 mg/sqm at the University Medical Center Regensburg. Thirty-five of these patients received bidirectional chemotherapy with additional intravenous application of 5FU/LV and 5 patients intraperitoneal oxaliplatin only. Perfusion time was 30 and 60 minutes, respectively. A matched-pair analysis was performed to compare IP oxaliplatin to our former standard HIPEC with mitomycin C and doxorubicin. Matching criteria were operating time, age and sex. Results: The mean operating time in the OX and the MMC group was 315 and 313 minutes, respectively. The mean age was 52 and 51 years, and 15 versus 16 patients were female, respectively. Median hospital stay was 15.5 days in the OX group and 17 days in the MMC group. The median stay on ICU was one day in both groups. The grade 3/4 morbidity rate was 42.5 % versus 37.5 % (p = 0.648). Five versus six patients had to be reoperated. Perioperative morbidity was 2.5 % versus 0 %. Main complications in the OX group were pleural effusion (5), thrombosis (2), cardiac arrhythmia (2), and abscess (2). In the MMC group postoperative morbidity was mainly caused by ileus (4), anastomotic leakage (3), pulmonary embolism (2), and wound infection (2). Conclusions: Our data suggest that the use of IP oxaliplatin in the context of CRS and HIPEC does not increase perioperative morbidity and/or mortality rate. Nevertheless, randomized controlled trials are required to determine the best intraperitoneal chemotherapeutic regimen regarding toxicity and oncological outcome. No significant financial relationships to disclose.

Peritoneal carcinomatosis of colorectal origin: Impact of ovarian metastases.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 604-604
Author(s):  
Laurent Ghouti ◽  
Amandine Pinto ◽  
Sylvain Kirzin
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Ovarian Metastasis ◽  
Ovarian Metastases ◽  
Colorectal Origin ◽  
Grade Iii

604 Background: To compare survival and morbidity in women treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal carcinomatosis with or without ovarian metastases (OM). Methods: A prospectively maintained database was analyzed to identify women treated by CRS- HIPEC between 2009 and 2015. Results: Among 62 included women, 39 had ovarian metastasis (63%) with comparable PCI (10 vs. 7 p=0.15). OM patients experienced more frequent grade III/IV postoperative morbidity (56.4% vs. 30% p=0.04), and postoperative haemoperitoneum (23.1% vs 4.3% p=0.07) leading to more frequent reoperation (36 vs. 21.7% p=0.2). Among OM patients, 20 (52 %) had undergone ovariectomy previously to CRS-HIPEC procedure. Haemoperitoneum (30% vs 15% p=0.4) and reoperation (45% vs. 26% p=0.2) were more frequent if previous OM resection had been performed as compared to synchronous. The 36-month survival (94.7 % vs 61.7 %) was significantly impaired by OM (p=0.007) and 36- month survival without recurrence was better when ovariectomy was performed during CRS- HIPEC (24 % vs. 5.5%, p=0.4). Conclusions: Survival and morbidity of patients with CRS-HIPEC for colorectal peritoneal carcinomatosis were impaired by the presence of OM and previous OM resection.

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