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Cytoreductive surgery and mitomycin C hyperthermic intraperitoneal chemotherapy with CO2 recirculation (HIPEC-CO2) for colorectal cancer peritoneal metastases: analysis of short-term outcomes

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Abstract

Peritoneal dissemination from colorectal cancer (CRC) has long been associated with unfavorable prognosis. However, in the last decades, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was able to obtain up to 30% 5-year survival rate in selected centers. Despite the wide diffusion of CRS and HIPEC, until now, there are no clear recommendations on the drug of choice for HIPEC nor its technique, and safety and efficacy data of HIPEC regimens and techniques are lacking. We performed a retrospective analysis of a prospectively maintained database of 26 CRS and mitomycin C HIPEC with CO2 recirculation (HIPEC-CO2) for CRC peritoneal metastasis (PM) performed at our center. The main endpoints were morbidity, mortality, the temperature of perfusate during HIPEC and metabolic changes throughout the procedure. Morbidity was assessed by analysis of postoperative adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). Continuous variables of Arterial Blood Gas (ABG) analysis at three time-points were compared by the Student t test. There were no postoperative deaths. The overall grade 3–4 CTCAE complications rate at 30 days was 38.4%, with ten severe adverse events occurring to six (23.0%) patients. The temperature within HIPEC perfusion maintained between 41 and 42 °C in all cases and we experienced no HIPEC-related intraoperative complications. We observed a significant difference between all baseline and pre-HIPEC ABG parameters evaluated but no statistically significant differences between pre- and post-HIPEC ABG outcomes. This study shows that mitomycin C HIPEC-CO2 is feasible and has a safety profile comparable to that of other HIPEC techniques reported in the literature. Further research is needed to validate prospectively the safety and efficacy of this technique.

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Authors and Affiliations

  1. Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

    Stefano Rotolo, Andrea Di Giorgio, Francesco Santullo, Miriam Attalla El Halabieh, Claudio Lodoli, Carlo Abatini & Fabio Pacelli

  2. Department of Surgical, Oncological and Oral Sciences (di.Chir.On.S.), University of Palermo, Palermo, Italy

    Stefano Rotolo

Authors
  1. Stefano Rotolo
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  2. Andrea Di Giorgio
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  3. Francesco Santullo
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  4. Miriam Attalla El Halabieh
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  5. Claudio Lodoli
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  6. Carlo Abatini
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  7. Fabio Pacelli
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Contributions

SR, FP and ADG: conceptualization. FS, RS, and ADG: methodology and validation. CA and MA: formal analysis. CA and MA: investigation. FP and MA: data curation. SR and ADG: writing—original draft preparation. SR, ADG, CA, FS, MA, and CL: writing—review and editing. All the authors have approved the final manuscript.

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Correspondence to Francesco Santullo.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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This study was reviewed and approved by the Institutional Review Board of Foundation Policlinico Universitario Agostino Gemelli IRCCS. Patient consent for inclusion was obtained in all the cases.

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Rotolo, S., Di Giorgio, A., Santullo, F. et al. Cytoreductive surgery and mitomycin C hyperthermic intraperitoneal chemotherapy with CO2 recirculation (HIPEC-CO2) for colorectal cancer peritoneal metastases: analysis of short-term outcomes. Updates Surg 73, 1443–1448 (2021). https://doi.org/10.1007/s13304-021-01034-2

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  • DOI: https://doi.org/10.1007/s13304-021-01034-2

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