Cytoreductive Surgery and HIPEC for Colorectal Peritoneal Metastases

Abstract

Introduction: Peritoneal metastases from colorectal cancer were historically considered a terminal condition. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has challenged this paradigm. This review assesses its current evidence base.

Methods: A comprehensive literature review was conducted focusing on randomized controlled trials, meta-analyses, and large registry series. Key outcomes were overall survival, disease-free survival, and major morbidity. The Peritoneal Cancer Index (PCI) and completeness of cytoreduction (CC) score were examined as prognostic factors.

Results: One landmark randomized trial demonstrated improved survival for CRS-HIPEC over systemic chemotherapy alone in selected patients. Median overall survival ranged from thirty to forty-five months in high-volume centers. Morbidity rates were significant, with major complications in twenty-five to forty percent, but mortality below four percent. A PCI below ten and CC-0 resection were strong predictors of favorable outcome.

Discussion: Selection criteria are crucial; favorable histology (low-grade mucinous) and limited extent of peritoneal disease yield best results. The role of HIPEC itself has been questioned by a recent trial showing no added benefit over CRS alone, though this remains debated due to methodological concerns. Neoadjuvant systemic chemotherapy does not worsen outcomes.

Conclusions: CRS-HIPEC offers long-term survival for a subset of patients with colorectal peritoneal metastases. Referral to specialized centers with multidisciplinary assessment is mandatory.