Mitomycin C Versus Oxaliplatin for Hyperthermic Intraperitoneal Chemotherapy After Cytoreductive Surgery for Appendiceal Neoplasms: A Systematic Review and Meta-Analysis
Flaviu Ionut Faur, Andrei Korodi, Ioana Adelina Faur, Andreea Adriana Neamtu, Mihai Cosmin Burta, Paul Pasca, Ciprian Duta, Vlad Braicu, Stelian Pantea, Amadeus Dobrescu, Catalin PirvuBackground: The choice between mitomycin C (MMC) and oxaliplatin (OX) for hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery for appendiceal neoplasms remains unresolved. Methods: PubMed/MEDLINE, Europe PMC, Scopus, Web of Science and ClinicalTrials.gov were searched to 1 October 2026 for studies comparing OX- and MMC-based HIPEC with outcomes in appendiceal neoplasms (PRISMA 2020; the protocol was not prospectively registered). Hazard ratios (HRs; OX vs. MMC, HR > 1 favours MMC) not reported by the studies were estimated from reconstructed individual patient data. Random-effects meta-analyses were performed; risk of bias was assessed with RoB 2 and ROBINS-I, and certainty with GRADE. Results: Ten studies (12 reports), including one randomised trial (n = 121), were included. In the randomised trial, HRs reconstructed from published Kaplan–Meier curves were 1.02 (95% CI 0.61–1.72) for disease-free survival and 1.05 (95% CI 0.59–1.85) for overall survival. In exploratory pooled analyses that also included observational cohorts, the HR for disease-free survival (4 studies, 343 patients) (OX vs. MMC) was 1.12 (95% CI 0.55–2.29; I2 = 60%), and 0.89 (95% CI 0.57–1.40) after exclusion of the only study reporting a significant difference. For overall survival (2 studies, 157 patients), the pooled HR was 0.97 (95% CI 0.56–1.69). Major morbidity did not differ (risk ratio 0.98, 95% CI 0.64–1.50). Leukopenia was more frequent with MMC, and health-related quality of life favoured OX in exploratory analyses of the randomised trial. Certainty of evidence was low to very low. Conclusions: Current evidence shows no survival difference between OX- and MMC-based HIPEC for appendiceal neoplasms, but it is sparse and imprecise. Regimen choice may reasonably be guided by toxicity, perfusion protocol and patient factors until adequately powered trials are available.