Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2011

01-02-2011 | Colorectal Cancer

Effects of Intraperitoneal Chemotherapy with Mitomycin C on the Prevention of Peritoneal Recurrence in Colorectal Cancer Patients with Positive Peritoneal Lavage Cytology Findings

Authors: Shingo Noura, MD, Masayuki Ohue, MD, Tatsushi Shingai, MD, Shingo Kano, MD, Hiroaki Ohigashi, MD, Masahiko Yano, MD, Osamu Ishikawa, MD, Akemi Takenaka, CT, Kohei Murata, MD, Masao Kameyama, MD

Published in: Annals of Surgical Oncology | Issue 2/2011

Login to get access

Abstract

Background

The detection of intraperitoneal free cancer cells in colorectal cancer (CRC) patients is associated with a poorer prognosis. The aim of this study was to investigate the effects of intraperitoneal chemotherapy (IPC) with mitomycin C (MMC) on preventing peritoneal recurrence in CRC patients with positive peritoneal lavage cytology findings.

Methods

A total of 52 CRC patients who had no clinically confirmed peritoneal dissemination and whose status of peritoneal lavage cytology was positive were investigated. Conventional peritoneal lavage cytology was performed. Overall, 31 of the 52 patients (59.6%) were administered IPC with MMC. Before closure of the abdomen, 4 silicon catheters were inserted into peritoneal cavity. After closure, the perfusate (diluting 20 mg MMC with 500 ml saline) was instilled from the catheter, and all catheters were clumped. All catheters were opened 1 h later.

Results

The mean follow-up period was 83.1 months. According to univariate analyses of all 52 patients and the subgroup of 36 patients with stage II or III tumors, patients with IPC had a significantly better peritoneal recurrence-free survival and cancer-specific survival than patients who did not receive IPC (P < 0.005). In multivariate analysis, IPC remained an independent prognostic factor for peritoneal recurrence-free survival in all patients.

Conclusions

It appears that IPC with MMC is an effective treatment to prevent peritoneal recurrence and prolong the cancer-specific survival in CRC patients without peritoneal dissemination, but who have positive peritoneal lavage cytology. It is necessary to verify the effectiveness of IPC with MMC in a prospective trial.
Literature
1.
Cohn I Jr. Implantation in cancer of the colon. Surg Gynecol Obstet. 1967;124:501–8.PubMed
2.
Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141:67–75.CrossRefPubMed
3.
Kato T, Yasui K, Hirai T, Kanemitsu Y, Mori T, Sugihara K, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of sprognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum. 2003;46:S22–S31.PubMed
4.
Higashiyama M, Kodama K, Higaki N, Takami K, Murata K, Kameyama M, et al. Surgery for pulmonary metastases from colorectal cancer: the importance of prethoracotomy serum carcinoembryonic antigen as an indicator of prognosis. Jpn J Thorac Cardiovasc Surg. 2003;51:289–96.CrossRefPubMed
5.
Ogunbiyi OA, McKenna K, Birnbaum EH, Fleshman JW, Kodner IJ. Aggressive surgical management of recurrent rectal cancer—is it worthwhile? Dis Colon Rectum. 1997;40:150–5.CrossRefPubMed
6.
Tanaka K, Noura S, Ohue M, Seki Y, Yamada T, Miyashiro I, et al. Doubling time of carcinoembryonic antigen is a significant prognostic factor after the surgical resection of locally recurrent rectal cancer. Dig Surg. 2008;25:319–24.CrossRefPubMed
7.
Sadahiro S, Suzuki T, Ishikawa K, Nakamura T, Tanaka Y, Masuda T, et al. Recurrence patterns after curative resection of colorectal cancer in patients followed for a minimum of ten years. Hepatogastroenterology. 2003;50:1362–6.PubMed
8.
Hase K, Ueno H, Kuranaga N, Utsunomiya K, Kanabe S, Mochizuki H. Intraperitoneal exfoliated cancer cells in patients with colorectal cancer. Dis Colon Rectum. 1998;41:1134–40.CrossRefPubMed
9.
Yamamoto S, Akasu T, Fujita S, Moriya Y. Long-term prognostic value of conventional peritoneal cytology after curative resection for colorectal carcinoma. Jpn J Clin Oncol. 2003;33:33–7.CrossRefPubMed
10.
Baskaranathan S, Philips J, McCredden P, Solomon MJ. Free colorectal cancer cells on the peritoneal surface: correlation with pathologic variables and survival. Dis Colon Rectum. 2004;47:2076–9.CrossRefPubMed
11.
Rekhraj S, Aziz O, Prabhudesai S, Zacharakis E, Mohr F, Athanasiou T, et al. Can intra-operative intraperitoneal free cancer cell detection techniques identify patients at higher recurrence risk following curative colorectal cancer resection: a meta-analysis. Ann Surg Oncol. 2008;15:60–8.CrossRefPubMed
12.
Noura S, Ohue M, Seki Y, Yano M, Ishikawa O, Kameyama M. Long-term prognostic value of conventional peritoneal lavage cytology in patients undergoing curative colorectal cancer resection. Dis Colon Rectum. 2009;52:1312–20.PubMed
13.
Yamaguchi A, Tsukioka Y, Fushida S, Kurosaka Y, Kanno M, Yonemura Y, et al. Intraperitoneal hyperthermic treatment for peritoneal dissemination of colorectal cancers. Dis Colon Rectum. 1992;35:964–8.CrossRefPubMed
14.
Brenner DE. Intraperitoneal chemotherapy: a review. J Clin Oncol. 1986;4:1135–47.PubMed
15.
Koga S, Hamazoe R, Maeta M, Shimizu N, Murakami A, Wakatsuki T. Prophylactic therapy for peritoneal recurrence of gastric cancer by continuous hyperthermic peritoneal perfusion with mitomycin C. Cancer. 1988;61:232–7.CrossRefPubMed
16.
Hamazoe R, Maeta M, Kaibara N. Intraperitoneal thermochemotherapy for prevention of peritoneal recurrence of gastric cancer. Final results of a randomized controlled study. Cancer. 1994;73:2048–52.CrossRefPubMed
17.
Yu W, Whang I, Suh I, Averbach A, Chang D, Sugarbaker PH. Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer. Ann Surg. 1998;228:347–54.CrossRefPubMed
18.
Sugarbaker PH, Gianola FJ, Speyer JC, Wesley R, Barofsky I, Meyers CE. Prospective, randomized trial of intravenous versus intraperitoneal 5-fluorouracil in patients with advanced primary colon or rectal cancer. Surgery. 1985;98:414–22.PubMed
19.
Hojo K. Surgery for far-advanced colorectal cancer–extension of surgical indication and its results. Nippon Geka Gakkai Zasshi. 1989;90:1428–31.PubMed
20.
Kameyama M, Fukuda I, Imaoka S, Masutani S, Ohigashi H, Sasaki Y, et al. Prevention of peritoneal dissemination after colorectal surgery—significance of MMC administration in abdominal cavity. Gan To Kagaku Ryoho. 1991;18:1808–11.PubMed
21.
Sobin LH, Wittekind Ch. TNM Classification of Malignant Tumours. 6th ed. New York: Wiley-Liss; 2002.
22.
Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.CrossRefPubMed
23.
Yan TD, Black D, Savady R, Sugarbaker PH. Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol. 2006;24:4011–9.CrossRefPubMed
24.
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-Year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.CrossRefPubMed
25.
Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg. 2008;248:829–35.PubMed
26.
Elias D, Lefevre JH, Chevalier J, Brouquet A, Marchal F, Classe JM, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.CrossRefPubMed
27.
Elias D, Gilly F, Boutitie F, Quenet F, Bereder JM, Mansvelt B, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8.CrossRefPubMed
28.
Smeenk RM, Verwaal VJ, Zoetmulder FA. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007;94:1408–14.CrossRefPubMed
29.
Levine EA, Stewart JH IV, Russell GB, Geisinger KR, Loggie BL, Shen P. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg. 2007;204:943–53; discussion 953–5.
30.
Hillan K, Nordlinger B, Ballet F, Puts JP, Infante R. The healing of colonic anastomoses after early intraperitoneal chemotherapy: an experimental study in rats. J Surg Res. 1988;44:166–71.CrossRefPubMed
31.
Martin JK Jr, Goellner JR. Abdominal fluid cytology in patients with gastrointestinal malignant lesions. Mayo Clin Proc. 1986;61:467–71.PubMed
32.
Wind P, Norklinger B, Roger V, Kahlil A, Guin E, Parc R. Long-term prognostic value of positive peritoneal washing in colon cancer. Scand J Gastroenterol. 1999;34:606–10.CrossRefPubMed
33.
Vogel P, Ruschoff J, Kummel S, Zirngibl H, Hofstadter F, Hohenberger W, et al. Prognostic value of microscopic peritoneal dissemination: comparison between colon and gastric cancer. Dis Colon Rectum. 2000;43:92–100.CrossRefPubMed
34.
Bosch B, Guller U, Schnider A, Maurer R, Harder F, Metzger U, et al. Perioperative detection of disseminated tumour cells is an independent prognostic factor in patients with colorectal cancer. Br J Surg. 2003;90:882–8.CrossRefPubMed
35.
Guller U, Zajac P, Schnider A, Bosch B, Vorburger S, Zuber M, et al. Disseminated single tumor cells as detected by real-time quantitative polymerase chain reaction represent a prognostic factor in patients undergoing surgery for colorectal cancer. Ann Surg. 2002;236:768–75; discussion 775–6.CrossRefPubMed
36.
Lloyd JM, McIver CM, Stephenson SA, Hewett PJ, Rieger N, Hardingham JE. Identification of early-stage colorectal cancer patients at risk of relapse post-resection by immunobead reverse transcription-PCR analysis of peritoneal lavage fluid for malignant cells. Clin Cancer Res. 2006;12:417–23.CrossRefPubMed
37.
Hara M, Nakanishi H, Jun Q, Kanemitsu Y, Ito S, Mochizuki Y, et al. Comparative analysis of intraperitoneal minimal free cancer cells between colorectal and gastric cancer patients using quantitative RT-PCR: possible reason for rare peritoneal recurrence in colorectal cancer. Clin Exp Metastasis. 2007;24:179–89.CrossRefPubMed
38.
Schott A, Vogel I, Krueger U, Kalthoff H, Schreiber HW, Schmiegel W, et al. Isolated tumor cells are frequently detectable in the peritoneal cavity of gastric and colorectal cancer patients and serve as a new prognostic marker. Ann Surg. 1998;227:372–9.CrossRefPubMed
39.
Cohen MS, Al-Kasspooles MF, Williamson SK, Henry D, Broward M, Roby KF. Combination intraperitoneal chemotherapy is superior to mitomycin C or oxaliplatin for colorectal carcinomatosis in vivo. Ann Surg Oncol. 2010;17:296–303.CrossRefPubMed
Metadata
Title
Effects of Intraperitoneal Chemotherapy with Mitomycin C on the Prevention of Peritoneal Recurrence in Colorectal Cancer Patients with Positive Peritoneal Lavage Cytology Findings
Authors
Shingo Noura, MD
Masayuki Ohue, MD
Tatsushi Shingai, MD
Shingo Kano, MD
Hiroaki Ohigashi, MD
Masahiko Yano, MD
Osamu Ishikawa, MD
Akemi Takenaka, CT
Kohei Murata, MD
Masao Kameyama, MD
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1319-2

Other articles of this Issue 2/2011

Annals of Surgical Oncology 2/2011 Go to the issue

Thoracic Oncology

Comparison of p53 and Epidermal Growth Factor Receptor Gene Status Between Primary Tumors and Lymph Node Metastases in Non-Small Cell Lung Cancers

Melanomas

Early versus Delayed Complete Lymphadenectomy in Melanoma: Insight from MSLT I

Pancreatic Tumors

Laparoscopic Pancreatectomy for Solid Pseudo-Papillary Tumors of the Pancreas is a Suitable Technique; Our Experience with Long-Term Follow-up and Review of the Literature

Endocrine Tumors

Reply to “25-Hydroxyvitamin D Status Does Not Affect Intraoperative Parathyroid Hormone Dynamics in Patients With Primary Hyperparathyroidism,” by Agarwal et al.

Translational Research and Biomarkers

Tyrosine Kinase Inhibitor PTK/ZK Enhances the Antitumor Effects of Interferon-α/5-Fluorouracil Therapy for Hepatocellular Carcinoma Cells

Head and Neck Oncology

Feasibility of Preservation of the Submandibular Gland During Neck Dissection in Patients With Early-Stage Oral Cancer