Dear Editor,
We read with interest the article by Tan et al. titled Platinum agents and mitomycin C-specific complications in cytroreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This article evaluated perioperative complications associated with particular chemotherapeutic agents used for HIPEC and found that the overall complication rates do not significantly differ after HIPEC with mitomycin-C (MMC) and platinum based agents. Additionally, it was found that renal impairment was more common and of greater severity when platinum agents were used [Citation1].
We would like to highlight a point that was not addressed in this paper but has increasing clinical significance. When trying to assess complications associated with various chemotherapeutic agents used with HIPEC, in addition to the type, duration of exposure, and dosage of the chemotherapeutic agent contributing to the possibility of acute kidney injury (AKI), combinations of multiple chemotherapeutic agents can potentially have a compounded nephrotoxic effect.
Our institution utilizes a combination of both cisplatin and MMC for laparoscopic HIPECs and some of our traditional HIPECs treating gastroesophageal adenocarcinoma. Despite the laparoscopic approach being significantly shorter than the traditional approach and associated with fewer postoperative complications in literature [Citation2,Citation3], we have seen trends in hypophosphataemia and hypocalcaemia when dual therapy with cisplatin and MMC is utilized with either approach. We have attributed these findings to the likely synergistic nephrotoxic effects of both agents being utilised together, as we have not seen these abnormalities in cases where single agent chemotherapy has been used. The paper by Tan and colleagues has encouraged us to evaluate the complications associated with the use of dual chemotherapy in HIPEC, particularly with regards to AKI.
Disclosure statement
No potential conflict of interest was reported by the authors.
References
- Tan GHC, Shannon NB, Chia CS, et al. Platinum agents and mitomycin C-specific complications in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Int Journal of Hyperthermia. 2017;1–6. doi:10.1080/02656736.2017.1345014
- Passcot G, Bakrin N, Isaac S, et al. Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies. Eur J Surg Oncol. 2014;40:957–962.
- Esquivel J, Averbach A, Chua TC. Laparoscopic cytoreductive suirgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surface malignancies: feasibility, morbidity, and outcome in an early experience. Ann Surg. 2011;253:764–768.