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Intraperitoneal hyperthermic perfusion with mitomycin C for colorectal cancer with peritoneal metastases

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Abstract

Background: Intraperitoneal (i.p.) metastases pose a special problem for surgical treatment because of their multiplicity and microscopic size. This study was designed to examine the feasibility and safety of i.p. hyperthermic perfusion (IPHP) with mitomycin C (MMC) for treating recurrent colorectal cancer.

Methods: Fifteen patients with metastatic colon cancer were treated. All patients underwent cytoreductive procedures leaving only residual i.p. metastases <1 cm in diameter. All patients had received prior systemic chemotherapy, but their disease had progressed. Intraperitoneal chemotherapy was administered through three large catheters (28 French) using a closed system of two pumps, a heat exchanger, and two filters. After the patient’s abdominal temperature reached 41°C, 45–60 mg of MMC was circulated intraperitoneally for 1 h.

Results: The majority of patients had various anastomoses: small bowel (n=11), large bowel (n=5), and urologic (n=5). No anastomotic complications occurred in any of the patients. One patient experienced severe systemic MMC toxicity, which caused cytopenia and respiratory depression. In all patients the carcinoembryonic antigen (CEA) level decreased after surgery and IPHP. Median follow-up was 10 months, and recurrence was defined as an elevation in CEA level. Disease recurred in three patients within 5 months, and disease recurred in seven other patients over the next 3 months; one patient remains clinically free of disease after 8 months.

Conclusion: Our data suggest that IPHP is a safe palliative method of treatment for patients with peritoneal carcinomatosis. The median patient response duration of 6 months may warrant consideration of a repeat IPHP procedure at that time.

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Authors and Affiliations

  1. From the Division of Surgical Oncology, Department of Surgery, The Ohio State University Hospitals, Columbus, Ohio, USA

    Schlomo Schneebaum MD & Edward W. Martin Jr MD

  2. Department of Surgery, The Ohio State University Hospitals, Columbus, Ohio, USA

    Mark W. Arnold MD

  3. Department of Pharmacology, The Ohio State University Hospitals, Columbus, Ohio, USA

    Alfred Staubus PhD

  4. Department of Circulation Technology, The Ohio State University Hospitals, Columbus, Ohio, USA

    David Dumond BS

  5. Department of Biostatistics, The Arthur G. James Cancer Hospital and Research Institute, Columbus, Ohio, USA

    Donn C. Young PhD

Authors
  1. Schlomo Schneebaum MD
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  2. Mark W. Arnold MD
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  3. Alfred Staubus PhD
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  4. Donn C. Young PhD
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  5. David Dumond BS
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  6. Edward W. Martin Jr MD
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Schneebaum, S., Arnold, M.W., Staubus, A. et al. Intraperitoneal hyperthermic perfusion with mitomycin C for colorectal cancer with peritoneal metastases. Annals of Surgical Oncology 3, 44–50 (1996). https://doi.org/10.1007/BF02409050

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  • DOI: https://doi.org/10.1007/BF02409050

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