Annals of surgical oncology · 2026
Impact of Systematic Discontinuation of Mitomycin C HIPEC for Colorectal Peritoneal Metastases on Oncologic Outcomes: A Propensity Score-Matched Analysis.
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Tanweer M Daniyal, Waheed Muhammad Talha, Paz Isaac B, Lwin Thinzar, Mohammed Hamza, Melstrom Laleh, Fong Yuman, Brar Gagandeep, Castillo Dani, Kasi Pashtoon Murtaza, Fakih Marwan, Raoof Mustafa
Аннотация
BACKGROUND: The PRODIGE7 trial demonstrated a lack of effectiveness of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for colorectal cancer peritoneal metastases (CRC-PM), prompting many centers to transition to mitomycin C (MMC)-based HIPEC. However, the oncologic benefit of MMC-HIPEC remains unclear.
METHODS: In 2021, our center systematically discontinued HIPEC for CRC-PM. We retrospectively compared consecutive patients who underwent MMC-HIPEC after complete CRS (2009-2021) with those undergoing CRS alone (2021-2024). Outcomes included recurrence-free survival (RFS), peritoneal RFS, and 90-day postoperative outcomes. Propensity score-matching was performed using age, sex, primary tumor location, extraperitoneal disease, completeness of cytoreduction score, peritoneal carcinomatosis index, and preoperative chemotherapy.
RESULTS: The study included 107 consecutive patients (median age, 56 years; median peritoneal carcinomatosis index [PCI], 8; 48% male; 45% left-sided primary tumor), 68 (64%) of whom underwent CRS-HIPEC with MMC. Most of the patients (75%) experienced recurrence. After matching, 96 patients remained (32 treated with CRS alone; 64 treated with CRS-HIPEC). Between CRS alone and CRS-HIPEC, RFS was comparable (median, 8.4 months [95% confidence interval {CI}, 5.6-12.7 months] vs. 8.7 months [95% CI, 6.2-11.0 months]; p = 0.527), as was peritoneal RFS (median 12.7 months [95% CI, 8.4-not reached {NR}] vs. 14.2 [95% CI, 8.7-19.8 months]; p = 0.806). The CRS-HIPEC patients had more respiratory complications (0% vs. 13%; p = 0.037) and longer hospital stays (median, 10 vs. 7 days; p < 0.001). Exploratory analyses suggested benefit in node-negative disease.
CONCLUSION: Omission of MMC-HIPEC did not compromise oncologic outcomes.
METHODS: In 2021, our center systematically discontinued HIPEC for CRC-PM. We retrospectively compared consecutive patients who underwent MMC-HIPEC after complete CRS (2009-2021) with those undergoing CRS alone (2021-2024). Outcomes included recurrence-free survival (RFS), peritoneal RFS, and 90-day postoperative outcomes. Propensity score-matching was performed using age, sex, primary tumor location, extraperitoneal disease, completeness of cytoreduction score, peritoneal carcinomatosis index, and preoperative chemotherapy.
RESULTS: The study included 107 consecutive patients (median age, 56 years; median peritoneal carcinomatosis index [PCI], 8; 48% male; 45% left-sided primary tumor), 68 (64%) of whom underwent CRS-HIPEC with MMC. Most of the patients (75%) experienced recurrence. After matching, 96 patients remained (32 treated with CRS alone; 64 treated with CRS-HIPEC). Between CRS alone and CRS-HIPEC, RFS was comparable (median, 8.4 months [95% confidence interval {CI}, 5.6-12.7 months] vs. 8.7 months [95% CI, 6.2-11.0 months]; p = 0.527), as was peritoneal RFS (median 12.7 months [95% CI, 8.4-not reached {NR}] vs. 14.2 [95% CI, 8.7-19.8 months]; p = 0.806). The CRS-HIPEC patients had more respiratory complications (0% vs. 13%; p = 0.037) and longer hospital stays (median, 10 vs. 7 days; p < 0.001). Exploratory analyses suggested benefit in node-negative disease.
CONCLUSION: Omission of MMC-HIPEC did not compromise oncologic outcomes.