Algethami N, Valdimarsson V, Verwaal V, Syk I. Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy. World J Gastrointest Oncol 2026; 18(7): 118400 [DOI: 10.4251/wjgo.v18.i7.118400]
Corresponding Author of This Article
Nader Algethami, MD, Department of Surgery, Skane University Hospital, Inga Marie Nilssons Gata 38, Malmo 21428, Skane, Sweden. nader.algethami@med.lu.se
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Surgery
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Algethami N, Valdimarsson V, Verwaal V, Syk I. Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy. World J Gastrointest Oncol 2026; 18(7): 118400 [DOI: 10.4251/wjgo.v18.i7.118400]
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 118400 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.118400
Prophylactic sodium thiosulfate reduces the risk and severity of acute kidney injury in oxaliplatin-based hyperthermic intraperitoneal chemotherapy
Nader Algethami, Valentinus Valdimarsson, Victor Verwaal, Ingvar Syk
Nader Algethami, Valentinus Valdimarsson, Victor Verwaal, Ingvar Syk, Department of Surgery, Skane University Hospital, Malmo 21428, Skane, Sweden
Nader Algethami, Valentinus Valdimarsson, Victor Verwaal, Ingvar Syk, Department of Surgery, Lund University, Malmo 21428, Skane, Sweden
Nader Algethami, Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Al Qunfudhah 21955, Makkah al Mukarramah, Saudi Arabia
Author contributions: Algethami N performed the statistical analyses and drafted the initial manuscript, finalized the manuscript; Algethami N and Valdimarsson V collected the data and ensured data quality; Valdimarsson V, Verwaal V, and Syk I critically reviewed the draft, verified the data analysis, and made important intellectual contributions to the final version; Verwaal V and Syk I conceived the idea for the manuscript; and all authors approved the manuscript before submission and have accepted responsibility for the entire content of the manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Gothenburg Department of Medicine 1, approval No. 2020/03504.
Informed consent statement: No informed consent to participate in the study was required by the Swedish Ethical Review Authority, due to the retrospective nature and the anonymous data used.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets collected and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request.
Corresponding author: Nader Algethami, MD, Department of Surgery, Skane University Hospital, Inga Marie Nilssons Gata 38, Malmo 21428, Skane, Sweden. nader.algethami@med.lu.se
Received: December 31, 2025 Revised: January 28, 2026 Accepted: April 8, 2026 Published online: July 15, 2026 Processing time: 187 Days and 13.2 Hours
Abstract
BACKGROUND
Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved outcomes for patients with peritoneal carcinomatosis (PC). However, this treatment carries a significant risk of acute kidney injury (AKI), especially with cisplatin-based regimens. Sodium thiosulfate (ST) is established as a nephroprotective treatment in cisplatin-based HIPEC, but its efficacy in oxaliplatin-based HIPEC remains unexplored.
AIM
To evaluate the protective effects of ST in patients undergoing oxaliplatin-based HIPEC for colorectal PC.
METHODS
This retrospective single-center study included 119 patients who underwent CRS combined with oxaliplatin-based HIPEC for colorectal PC between 2018 and 2024. ST was introduced in 2022, and patients were grouped as ST-treated (n = 46) and non-ST-treated (n = 73) based on the treatment period. The primary endpoint was the incidence of AKI. Secondary outcomes were postoperative plasma creatinine levels, estimated glomerular filtration rate, severity of AKI, and rate of postoperative complications. Outcomes were analyzed using multivariate logistic regression, including sensitivity analysis.
RESULTS
The incidence of AKI was significantly lower in the ST-treated group (28%) compared with the non-ST-treated group (66%). Multivariate analysis confirmed ST as an independent factor associated with a reduced risk of AKI. Peak plasma creatinine and mean postoperative creatinine levels were also significantly lower in the ST-treated group. The rate of postoperative complications other than AKI was similar between the groups.
CONCLUSION
Prophylactic administration of ST significantly reduces the incidence and severity of AKI in patients undergoing CRS combined with oxaliplatin-based HIPEC. These findings suggest that ST may be considered as a nephroprotective strategy in oxaliplatin-based HIPEC protocols; however, further prospective studies are warranted to confirm these results.
Core Tip: This retrospective single-center study demonstrates that prophylactic sodium thiosulfate (ST) markedly reduces both the incidence and severity of acute kidney injury in patients undergoing cytoreductive surgery with oxaliplatin-based hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. Patients receiving ST showed significantly lower postoperative creatinine levels and fewer kidney injuries without an increased risk of other postoperative complications. These findings indicate a clear nephroprotective benefit in this setting and support consideration of ST in oxaliplatin-based hyperthermic intraperitoneal chemotherapy protocols, although future prospective studies are warranted to confirm these results.
