The Mitomycin versus Oxaliplatin debate on HIPEC in colorectal cancers - An updated systematic review and Meta-analysis

Introduction

Following the PRODIGE-7 trial, surgeons have shifted to the use of Mitomycin-based HIPEC from Oxaliplatin for colorectal peritoneal metastasis. While preclinical studies have demonstrated the superiority of Mitomycin over oxaliplatin, clinical studies report variable results. The objective of the meta-analysis was to determine the most efficacious drug after cytoreduction for colorectal peritoneal metastasis.

Methods

he databases searched were PubMed, Cochrane Library, Scopus, CINHAL (EBSCO), and Google Scholar based on the following concepts: colorectal, peritoneal, cytoreduction, Mitomycin, and Oxaliplatin. The risk of bias was assessed using the Newcastle-Ottawa scale and certainty of the evidence was assessed using the GRADE Pro tool. The analysis was carried out using the log hazard ratio as the outcome measure for survival data. All syntheses used the Random-effects model and were reported for Oxaliplatin-based HIPEC with MMC as the reference.

Results

Thirteen studies with 3406 patients were included in the quantitative meta-analysis. The pooled hazard ratio for overall survival was 1.03 (95 % CI: 0.786–1.349) from ten studies. Six studies reported disease-free survival and the pooled hazard ratio was 0.941 (95 % CI: 0.683–1.297). Both survival estimates had moderate statistical heterogeneity. The evidence was of very low certainty for all the outcomes due to the non-randomized nature of studies, clinical and statistical heterogeneity, serious risk of bias due to uncontrolled measured confounding, selection bias, and unequal follow-up durations.

Conclusion

Our systematic review and meta-analysis found no significant difference in survival outcomes or postoperative morbidity between MMC and Oxaliplatin-based HIPEC.