Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Carcinomatosis : Higher Complication Rate for Oxaliplatin Compared to Mitomycin C
Rouers, A.; Laurent, S.; Detroz, Bernardet al.
2006 • In Acta Chirurgica Belgica, 106, p. 302-306
[en] 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.
Disciplines :
Surgery
Author, co-author :
Rouers, A.
Laurent, S.
Detroz, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Meurisse, Michel ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Language :
English
Title :
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Carcinomatosis : Higher Complication Rate for Oxaliplatin Compared to Mitomycin C
PARKIN D. M., PISANI P., FERLAY J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer, 1999, 80 (6): 827-41.
CHU D. Z., LANG N. P., THOMPSON C., OSTEEN P. K., WESTBROOK K. C. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer, 1989, 63 (2): 364-7.
SADEGHI B., ARVIEUX C., GLEHEN O. et al Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer, 2000, 88 (2): 358-63.
SUGARBAKER P. H., CUNLIFFE W. J., BELLIVEAU J. et al. Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol, 1989, 16 (4 Suppl 6): 83-97.
ELIAS D., BLOT F., EL OTMANY A. et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer, 2001, 92 (1): 71-6.
DETROZ B., LAURENT S., HONORE P. et al. Rationale for hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment or prevention of peritoneal carcinomatosis. Acta Chir Belg, 2004, 104 (4): 377-83.
ELIAS D., MATSUHISA T., SIDERIS L. et al. Heated intra-operative intraperitoneal oxaliplatin plus irinotecan after complete resection of peritoneal carcinomatosis: pharmacokinetics, tissue distribution and tolerance. Ann Oncol, 2004, 15 (10) : 1558-65.
SUGARBAKER P. H. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol, 1998, 14 (3): 254-61.
SHEN P., HAWKSWORTH J., LOVATO J. et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol, 2004, 11 (2): 178-86.
SUGARBAKER P. H. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol, 1999, 43 Suppl: S15-S25.
SUGARBAKER P. H., SCHELLINX M. E., CHANG D., KOSLOWE P., VON MEYERFELDT M. Peritoneal carcinomatosis from adenocarcinoma of the colon. World J Surg, 1996, 20 (5): 585-91.
EILBER F. C., ROSEN G., FORSCHER C. et al. Surgical resection and intraperitoneal chemotherapy for recurrent abdominal sarcomas. Ann Surg Oncol, 1999, 6 (7): 645-50.
HALLER D. G. Chemotherapy in gastrointestinal malignancies. Semin Oncol, 1988, 15 (3 Suppl 4): 50-64.
STORM F. K. Clinical hyperthermia and chemotherapy. Radiol Clin North Am, 1989, 27 (3): 621-7.
ANDRE T., BONI C., MOUNEDJI-BOUDIAF L. et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 2004, 350 (23): 2343-51.
PESTIEAU S. R., BELLIVEAU J. F., GRIFFIN H. et al. Pharmacokinetics of intraperitoneal oxaliplatin: experimental studies. J Surg Oncol, 2001, 76 (2): 106-14.
ELIAS D., BONNAY M., PUIZILLOU J. M. et al. Heated intra-operative intraperitoneal oxaliplatin after complete resection of peritoneal carcinomatosis: pharmacokinetics and tissue distribution. Ann Oncol, 2002, 13 (2): 267-72.
ELIAS D., SIDERIS L., POCARD M. et al. Efficacy of intraperitoneal chemohyperthermia with oxaliplatin in colorectal peritoneal carcinomatosis. Preliminary results in 24 patients. Ann Oncol, 2004, 15 (5): 781-5.
VERWAAL V. J., VAN TINTEREN H., RUTH S. V. et al. Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol, 2004, 85 (2): 61-7.
MAKRIN V., LEV-CHELOUCHE D., EVEN SAPIR E. et al. Intraperitoneal heated chemotherapy affects healing of experimental colonic anastomosis: an animal study. J Surg Oncol, 2005, 89 (1): 18-22.
VAN DER KOLK B. M., DE MAN B. M., WOBBES T. et al. Is early postoperative treatment with 5-fluorouracil possible without affecting anastomotic strength in the intestine? Br J Cancer, 1999, 79 (3-4): 45-50.
DINDO D., DEMARTINES N., CLAVIEN P. A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240 (2): 205-13.
GLEHEN O., KWIATKOWSKI F., SUGARBAKER P. H. et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: amulti-institutional study. J Clin Oncol, 2004, 22 (16): 3284-92.
