Avoidance of Early Post-Operative Intraperitoneal Chemotherapy (EPIC) Following Peritonectomy with Heated Intraperitoneal Chemotherapy (HIPEC) Significantly Reduces Cost and Hospital Stay

Abstract

Aims: Peritoneal carcinomatosis is treated with Cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) with or without Early Postoperative Intraperitoneal Chemotherapy (EPIC) depending on the pathology involved. Since 2010 heated intraperitoneal oxaliplatin has been utilised in our institution. Our aim was to determine if there was a significant cost difference between patients receiving oxaliplatin and those requiring five additional days of EPIC. Methods: We retrospectively analysed 30 patients from our database. 15 patients underwent cytoreductive surgery, heated intraperitoneal oxaliplatin (350mg/m 2 ) and 5-fluorouracil (FU) intravenously administered intraoperatively. We compared those patients with 15 patients who underwent CRS, heated intraperitoneal mitomycin C (10-25mg/m 2 ) as well as EPIC with 5-FU (600-800mg/m 2 ) on postoperative days 1 to 5. Patients were matched for age, gender, pathology and peritoneal carcinomatosis index (PCI). Results: There was no significant difference between radiology (p=0.6) and transfusion costs (p=0.4). The chemotherapy costs in the oxaliplatin group were significantly higher (p=0.001) however overall bed costs including ward, HDU and ICU were significantly lower in the oxaliplatin group (p 0.029). There was a higher percentage of patients in the EPIC group that had postoperative ileus (p 0.4), rate of infection (p 0.1), fistula formation (p 0.03), return to theatre (p 0.2) and collection formation (p 0.07) compared to the oxaliplatin group. The overall cost was significantly lower in the oxaliplatin group (p 0.038). There was no significant survival benefit between both groups (p 0.3). Conclusion: In colorectal cancer the cost and complications of EPIC following HIPEC are unjustified. We now use oxaliplatin HIPEC as our standard regimen in colorectal cancer and appendiceal adenocarcinoma.