Severe Neutropenia After HIPEC Using Mitomycin-C

Evaluation parameters

• Preoperative period

• Obtaining informed consent
• Assessment of baseline clinical characteristics: vital sign, BMI, BSA, ASA classification, ECOG, CBC, CEA level
• Before 1 day of surgery, assessment of QoR-40 questionnaires
• Intra-operative period

• CRS / HIPEC
• Assessment for peritoneal cancer index, complete cytoreduction score
• HIPEC procedures: HIPEC was performed using MMC 35 mg/m2 at 41-43℃ for 90 min. Following the HIPEC triple method, MMC 35 mg/m2 was mixed with 3L of Physioneal PD-2 1.5% peritoneal dialysis solution and administered into the intraperitoneal cavity at 50% of the dose at the beginning of HIPEC, 25% of the dose at 30 min, and 25% of the dose at 60 min.
• Intraoperative samplings of blood and peritoneal fluids during HIPEC :

• Blood sampling of 5 ml at each time point (baseline, 0 (HIPEC starting point), 15, 30, 45, 60, 75, 90, 120 min)
• Peritoneal fluid sampling of 5 ml at each time point (baseline, 0 (HIPEC starting point), 15, 30, 45, 60, 75, 90 min)
• Postoperative period : Postoperative assessment until the discharge date or postoperative 14th days.

• Daily assessment before discharge : vital sign, transfusion, neutropenia occurrence, adverse events, hematologic blood test (CBC, absolute neutrophil count (ANC), postoperative complications, use of G-CSF, ICU admission (If severe neutropenia occurs in the postoperative period, the patient assigns in arm I.)
• CEA level: postoperative 5th day
• QoR-40 questionnaires: postoperative 4th and 7th days

Inclusion criteria

• Joined the study voluntarily and signed informed consent form
• Patients who diagnosed colorectal cancer or appendiceal mucinous neoplasm with peritoneal metastases
• Patients who undergo CRS/HIPEC using MMC
• ECOG ≤ 1

Exclusion criteria

• Patients who received synchronous operations for liver or lung metastatic sites during CRS/HIPEC
• Previous histories who underwent CRS/HIPEC
• Patients who received palliative 3rd line chemotherapy
• Patients who received chemotherapy within 1 year to treat other cancers
• Patients who had PCD cathethers for ascites control
• ECOG ≥2
• Infectious status
• Age<19 years old
• Pregnant or breast-feeding women or people during the birth-period who refused to take contraceptives

Drop-out criteria

• Hospital stay > 30 days