Abstract
BackgroundMitomycin-C (MMC) is the most commonly used chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS). However, MMC has a side effect of myelosuppression. This study aimed to evaluate the clinical manifestations and impact of MMC-induced neutropenia after CRS and HIPEC in colorectal cancer patients.MethodsA total of 124 colorectal cancer patients who underwent CRS with HIPEC between March 2015 and January 2019 were evaluated. Patients with malignancies of non-colorectal origin, hospital stay longer than 60 days, peritoneal cancer index > 30, and complete cytoreduction score > 2 were excluded. MMC 35 mg/m2 was administered for 90 min at 41–43 °C. The patients were divided into three groups: no neutropenia, mild neutropenia (grade 1–2), and severe neutropenia (grade 3–4).ResultsIn total, mild and severe neutropenia occurred in 30 (24.2%) and 48 (38.7%) patients, respectively. Age and body surface area were significantly different among the neutropenia groups. Severe neutropenia developed significantly earlier than mild neutropenia (6.9 days vs. 10.4 days, p < 0.001) and also lasted significantly longer (4.6 days vs. 2.5 days, p = 0.005). The rate of major postoperative complications was significantly higher in the severe neutropenia group than in the no and mild neutropenia groups (8.3% vs. 6.7% vs. 6.5%, p = 0.015)ConclusionsSevere neutropenia starts earlier and lasts longer than mild neutropenia after CRS and HIPEC using an MMC triple method. The higher rate of major postoperative complications in patients with severe neutropenia highlights the importance of postoperative management during the neutropenia period.
Highlights
Mitomycin-C (MMC) is the most commonly used chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS)
The preoperative Body surface area (BSA) was significantly higher in the no neutropenia group than in the mild or severe neutropenia group
Primary colorectal cancer resection was performed before CRS with HIPEC in 58.3%, 70.0%, and 56.5% of the patients in the severe, mild, and no neutropenia groups, respectively
Summary
Mitomycin-C (MMC) is the most commonly used chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS). This study aimed to evaluate the clinical manifestations and impact of MMC-induced neutropenia after CRS and HIPEC in colorectal cancer patients. A total of 124 colorectal cancer patients who underwent CRS with HIPEC between March 2015 and January 2019 were evaluated. Patients with malignancies of non-colorectal origin, hospital stay longer than 60 days, peritoneal cancer index [ 30, and complete cytoreduction score [ 2 were excluded. The patients were divided into three groups: no neutropenia, mild neutropenia (grade 1–2), and severe neutropenia (grade 3–4). Mild and severe neutropenia occurred in 30 (24.2%) and 48 (38.7%) patients, respectively. Severe neutropenia developed significantly earlier than mild neutropenia (6.9 days vs 10.4 days, p\0.001) and lasted significantly longer (4.6 days vs 2.5 days, p = 0.005).
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