Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: a single-institution experience

Abstract

Background

Peritoneal metastases (PM) from colorectal cancer are associated with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been proposed for selected patients, although its role remains debated. This study evaluates the efficacy and safety of CRS plus HIPEC in a single institution.

Patients and methods

This retrospective study included patients with colorectal PM treated with CRS and HIPEC between 2009 and 2024. Preoperative staging involved CT and/or MRI, and all cases were discussed in a multidisciplinary team. Disease burden was assessed using the Peritoneal Cancer Index (PCI), and completeness of cytoreduction (CC score) was recorded. HIPEC was performed with oxaliplatin (360 mg/m² at 42 °C for 90 minutes). Overall survival (OS) was the primary endpoint; disease-free survival (DFS) and morbidity were secondary endpoints.

Results

Fifty patients (mean age 54 years) were included. Complete cytoreduction (CC-0/1) was achieved in 88% of cases, with a median PCI of 8.33. Severe complications occurred in 18% of patients, with no 30-day mortality. After a median follow-up of 34 months, median OS was 49 months; 1- and 5-year OS rates were 96% and 54%, respectively. Median DFS was 14 months. PCI, CC score, and prior surgical score were associated with OS on univariate analysis, while PCI and CC score remained independent prognostic factors.

Conclusions

CRS plus HIPEC is a feasible and effective treatment for selected patients with colorectal PM, with acceptable morbidity. Low PCI and complete cytoreduction are key predictors of improved survival.