Comparison of hyperthermic intraperitoneal chemotherapy regimens for treatment of peritoneal-metastasized colorectal cancer

Table 1 Patients, tumours and treatment, n (%)

	All, n = 102	MMC, n = 34	Oxaliplatin/5-FU, n = 68	P value1
Male sex	60 (59)	24 (40)	36 (60)	0.135
Age in yr, median (range)	57.2 (23-80)	56.3 (23-73)	57.7 (40-80)	0.884
BMI in kg/m²	25.3 (15.9-39.6)	25.5 (19.1-33.6)	25.2 (15.9-39.6)	0.266
ASA-score				0.002b
1-2	49 (48)	24 (71)	25 (37)
3-4	53 (52)	10 (29)	43 (63)
Tumour location				1.000
Colon	91 (89)	30 (88)	61 (90)
Rectum	11 (11)	4 (12)	7 (10)
Surgical approach				0.257
Complete cytoreduction	99 (97)	32 (94)	67 (99)
Palliative resection	3 (3)	2 (6)	1 (2)
Resection
Peritoneum	81 (80)	29 (85)	52 (77)	0.437
Omentum	66 (65)	26 (77)	40 (59)	0.123
Colon/rectum	55 (54)	18 (53)	37 (54)	1.000
Small intestine	49 (48)	15 (44)	34 (50)	0.675
Liver	42 (41)	13 (38)	29 (43)	0.831
Diaphragm	16 (16)	9 (27)	7 (10)	0.045a
Other	63 (64)	21 (68)	42 (62)	0.655
Pretherapeutic T stage				0.027a
T1	2 (2)	0	2 (3)
T2	2 (2)	0	2 (3)
T3	34 (34)	13 (41)	21 (31)
T4a	40 (40)	17 (53)	23 (34)
T4b	22 (22)	2 (6)	20 (30)
Pretherapeutic N stage				1.000
N0	26 (26)	8 (25)	18 (27)
N+	73 (74)	24 (75)	49 (73)
Pretherapeutic M stage				1.000
M0	36 (37)	12 (35)	24 (38)
M+	62 (63)	22 (65)	40 (63)
Tumour grading				1.000
G1	0	0	0
G2	59 (63)	22 (65)	37 (63)
G3	34 (37)	12 (35)	22 (37)
PCI score (0-39)	9.4 (0-39)	12.0 (0-39)	8.1 (0-30)	0.312
Postop CC-level				0.350
CC0	89 (87)	28 (82)	61 (90)
CC1	8 (8)	3 (9)	5 (7)
CC2/3	5 (5)	3 (9)	2 (3)
Mucinous cells	21 (21)	6 (18)	15 (22)	0.796

¹Fisher's exact test.

^aP < 0.05.

^bP < 0.01. 5-FU: 5-Fluorouracil; ASA: American Society of Anesthesiologists; BMI: Body mass index; MMC: Mitomycin C; PCI: Peritoneal cancer index.

Table 2 Impact of hyperthermic intraperitoneal chemotherapy regimen on perioperative outcome, n (%)

Parameter	Total, n = 102	Mitomycin, n = 34	Oxaliplatin/5-FU, n = 68	P value1
Median operative time in min	379 (95-774)	410 (95-774)	363 (96-722)	0.260
Median blood substitution in mL	105 (0-1800)	185 (0 -1800)	66 (0-1200)	0.068
Hospitalization in d	12 (2-46)	11,4 (4-35)	12,4 (2-46)	0.315
ICU stay in d	6.3 (2-50)	4.4 (2-9)	7.2 (2-50)	0.035a
In-hospital mortality
Rate of complications	57 (56)	12 (35)	45 (66)	0.003b
Cardio-pulmonary morbidity
Pneumonia	5 (5)	2 (6)	3 (4)	0.542
Re-intubation	2 (2)	0	2 (3)	0.442
Pulmonary embolism/thrombosis	2 (2)	0	2 (3)	0.442
Hematoma	2 (2)	1 (3)	1 (2)	0.558
Postoperative haemorrhage	4 (4)	1 (3)	3 (4)	0.593
Surgical morbidity
Intestinal atony	23 (23)	3 (9)	20 (30)	0.015a
Wound infection	15 (15)	5 (15)	10 (15)	0.608
Abdominal abscess	13 (13)	5 (15)	8 (12)	0.448
Abdominal infection	15 (15)	1 (3)	14 (21)	0.013a
Burst abdomen	8 (8)	1 (3)	7 (10)	0.184
Peritonitis	6 (6)	0	6 (9)	0.081
Sepsis	6 (6)	0	6 (9)	0.081
Renal complications
Urinary retention	4 (4)	0	4 (6)	0.192
Renal failure	7 (7)	2 (6)	5 (7)	0.344
Urinary tract infections	8 (8)	0	8 (12)	0.034a
Severity of complicationsb				0.029a
Grade 0/I	45 (44)	22 (65)	23 (34)
Grade II	23 (23)	3 (9)	20 (30)
Grade IIIa	16 (16)	5 (15)	11 (16)
Grade IIIb	10 (10)	3 (9)	7 (10)
Grade IV	8 (8)	1 (3)	7 (10)
Grade V (in-hospital mortality)	0	0	0
Mortality				0.139
30 d	5 (5)	4 (12)	1 (1)
90 d	11 (10)	5 (15)	6 (9)

¹Mann-Whitney U test/Fishers exact test.

^aP < 0.05.

^bP < 0.01. 5-FU: 5-Fluorouracil; ICU: Intensive care unit.

Table 3 Impact of other prognostic factors on overall survival

Predictor	n	Median survival in mo	P value1
Sex			0.884
Male	60	49
Female	42	57
Age			0.147
< 50 yr	27	38
≥ 50 yr	75	49
Preoperative BMI			0.423
< 18.5	4	4
18.5-25	49	53
25-30	35	51
> 30	14	49
ASA score			0.457
1-2	49	49
3-4	53	57
Primary tumour location			0.620
Colon	91	49
Rectum	11	23
Primary T-stage			0.669
T1-3	38	49
T4a	40	30
T4b	22	Not reached
Primary nodal stage			0.013a
N0	26	88
N1	31	51
N2a	19	30
N2b	23	18
Primary distant metastasis			0.046a
M0	36	57
M+	62	35
Primary tumour grading			0.010a
G2	59	51
G3	34	29
Primary tumour resection			0.035a
R0	76	51
R1	20	30
R2	4	16
Cytoreduction level			< 0.001b
CC0	89	49
CC1	10	12
CC2-3 + palliative resections	3	3
PCI-score			< 0.001b
< 10	56	51
10-20	29	27
20-30	11	10
> 30	5	9
Operation extent
Partial colectomy	55	53	0.189
No colon resection	47	31
Small bowel resection	49	30	0.355
No small bowel resection	53	51
Liver metastasis resection	42	27	0.024a
No liver resection	60	51
HIPEC regimen			0.139
MMC	34	30
Oxaliplatin/5-FU	68	Not reached

¹Univariate analysis by Kaplan-Meier method with log-rank test for the comparison of subgroups.

^aP < 0.05.

^bP < 0.01. 5-FU: 5-Fluorouracil; ASA: American Society of Anesthesiologists; BMI: Body mass index; HIPEC: Hyperthermic intraperitoneal chemotherapy; MMC: Mitomycin C; PCI: Peritoneal cancer index.