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.