Colorectal Carcinoma


The use of hyperthermic intraperitoneal chemoperfusion has been reported in numerous small case series, one prospective randomized trial comparing cytoreduction + HIPEC + adjuvant chemotherapy versus palliative chemotherapy alone, and one recent multicenter meta-analysis of non randomized data.

Most of the 13 reported non randomized phase II series concern small patient numbers and report 3 year survival rates ranging from 20-60%. (1 - 14)

These results warranted a randomized trial, ultimately reported by Verwaal et al in 2003. (15)
They randomized 105 patients with PC of colorectal origin to either systemic 5-FU based chemotherapy and palliative surgery or cytoreduction / HIPEC followed by systemic chemotherapy. Perfusion was performed during 90 minutes at a temperature >40° C using mitomycin C. Median survival was significantly better in the HIPEC group (22.3 months vs 12.6 months; p=0.032).

Survival was significantly worse if more than 5 abdominal regions were affected or when resection was macroscopically incomplete (R0).

Recently, a multicenter retrospective series of 506 patients with PC of colorectal cancer (appendiceal cancers were excluded) treated with cytoreduction followed by early postoperative chemotherapy, HIPEC, or both was reported by Glehen et al. (16)
Overall, median survival was 19.2 months, very similar to the result reported by Verwaal with the use of HIPEC. Survival was significantly better when complete cytoreduction could be achieved (32.4 months versus 8.4 months, p>0.001). Lymph node and liver involvement, neoadjuvant chemotherapy, and poor histological grade adversely affected survival. Interestingly, survival results were not different with either early postoperative chemotherapy or HIPEC alone, but improved with the combined use of both modalities.


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