Pilot Study: Prophylatic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Colorectal Cancers at High Risk of Developing Peritoneal Metastases in a Tertiary Asian Centre

Abstract

Introduction: The second most common site of Colorectal Cancer (CRC) recurrence is the peritoneum. The primary aim of this study was to assess feasibility of prophylactic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Asian patients, and to determine the associated morbidity and time to start of adjuvant chemotherapy. Materials and methods: Patients at high-risk of developing Peritoneal Metastases (PM) include the following: T4 on imaging, krukenburg tumours, perforated tumours, limited synchronous PM, and peritoneal fluid cytology positive for malignant cells. Recruited patients were divided into two groups; newly diagnosed CRC patients with any of the high-risk features (Group 1), and patients who had recent surgery (less than 8 weeks from recruitment) with histological confirmation of high-risk features (Group 2). Results: 12 patients were recruited, of which there were 10 Group 1 patients and 2 Group 2 patients. Of the 10 patients in Group 1, 7 had T4 disease and another 3 had limited PM suspected on staging scans. All patients completed the Cytoreductive Surgery (CRS) and HIPEC procedure with no mortalities. 2 patients experienced major morbidity. Median time to adjuvant chemotherapy was 46 days (IQR 42.75-52.85). Median Length of Stay (LOS) was 13.5 days (IQR 8-15) comparable to our control group (N=214), which included all patients undergoing CRS and HIPEC with a median LOS of 14 days (IQR 11-19, p=0.11). Conclusion: Prophylactic HIPEC is feasible in a highly selected group of patients with newly diagnosed locally advanced CRC and those with limited synchronous PM, with appropriate time to receiving adjuvant chemotherapy.