Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin

Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant to systemic chemotherapy. We performed a phase I/II tr ial to investigate the feasibility and effectiveness of extensive cytoreduc tive surgery in combination with intra-operative hyperthermic intraperitone al chemotherapy (HIPEC) in these patients. 29 patients with peritoneal carc inomatosis of colorectal origin without evidence of distant metastases unde rwent cytoreductive surgery and intra-operative HIPEC with mitomycin-C (MMC ), followed by systemic chemotherapy with 5-fluorouracil (5-FU)/leucovorin. Surgical complications occurred in 11 patients (38%). One patient died dir ectly related to the treatment. resulting in a mortality rate of 3%. MMC to xicity existed mainly of leucocytopenia (in 15 patients: 52%). After a medi an follow-up of 38 months (range 26-52 months) we found a 2- and 3-year sur vival rate (Kaplan-Meier) of 45 and 23%, respectively. Extensive cytoreduct ive surgery and HIPEC is feasible in patients with peritoneal seeding of co lorectal cancer. First results suggest that a higher median survival could be achieved compared with conventional palliative surgery and systemic chem otherapy, therefore a randomised phase III study is now being conducted. (C ) 2001 Elsevier Science Ltd. All rights reserved.