Colorectal Peritoneal Metastases Treated by Perioperative Systemic Chemotherapy and Cytoreductive Surgery With or Without Mitomycin C-Based HIPEC: A Comparative Study Using the Peritoneal Surface Disease Severity Score (PSDSS)

  • Dario BarattiEmail author
  • Shigeki Kusamura
  • Norfarizan Azmi
  • Marcello Guaglio
  • Matteo Montenovo
  • Marcello Deraco
Peritoneal Surface Malignancy



The Prodige-7 trial has questioned the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal metastases from colorectal cancer (CRC-PM).

Patients and Methods

We compared a prospectively collected group of 48 patients undergoing oxaliplatin/irinotecan-based perioperative systemic chemotherapy (s-CT) with targeted agents, and cytoreductive surgery (CRS) (no-HIPEC group) with 48 controls undergoing the same perioperative s-CT and CRS/HIPEC (HIPEC group). Patients were matched (1:1) according to the Peritoneal Surface Disease Severity Score, completeness of cytoreduction, history of extraperitoneal disease (EPD), and Peritoneal Cancer Index.


The groups were comparable, except for a higher number of patients in the HIPEC group with World Health Organization performance status 0, pN2 stage primary tumor, and treated with preoperative s-CT. Forty-one patients in the no-HIPEC group and 43 patients in the HIPEC group had optimal comprehensive treatment (P = 0.759), defined as complete cytoreduction of PM and margin-negative EPD resection. Median follow-up was 31.6 months in the no-HIPEC group and 39.9 months in the HIPEC group. Median overall survival was 39.3 months in the no-HIPEC group and 34.8 months in the HIPEC group (P = 0.702). In the two groups, severe morbidity occurred in 14 (29.2%) and 13 (27.1%) patients, respectively (P = 1.000), with no operative deaths. On multivariate analysis, left-sided primary and curative treatment independently correlated with better survival while HIPEC did not (hazard ratio 0.73; 95% confidence interval 0.47–1.15; P = 0.178).


Our results confirmed that, in selected patients, perioperative s-CT and surgical treatment of CRC-PM resulted in unexpectedly high survival rates. Mitomycin C-based HIPEC did not increase morbidity but did not impact prognosis.



N.A. is a fellow of the European School of Peritoneal Surface Oncology.


The authors have no financial interests to disclose.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Dario Baratti
    • 1
    Email author
  • Shigeki Kusamura
    • 1
  • Norfarizan Azmi
    • 2
  • Marcello Guaglio
    • 1
  • Matteo Montenovo
    • 1
  • Marcello Deraco
    • 1
  1. 1.Peritoneal Malignancy Program, Department of SurgeryNational Cancer InstituteMilanItaly
  2. 2.Department of General SurgeryHospital Tuanku Ja’afarSerembanMalaysia

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