Patient selection in those undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases - systematic review and meta-analysis of prognostic factors in large cohorts
In brief
Peritoneal burden and complete removal predict survival after surgery with heated chemotherapy
Across 45 studies of colorectal cancer spread to the peritoneum, the amount of cancer and whether surgeons could remove it all were the strongest survival predictors after surgery with heated chemotherapy. Major complications and several tumor features also tracked with worse outcomes; systemic treatment showed no significant survival effect in this analysis, underscoring the need for careful patient selection.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 3 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Amanda Liesegang, Halle Powell, Anshini Jain, Helen Mohan, Jeanne Tie, Nicholas Clemons, et al.
- PMID
- 42838780
- DOI
- 10.1016/j.ejso.2026.112184
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 8 October 2026): Prognostic factors for CRS‑HIPEC in colorectal peritoneal metastases
Abstract
INTRODUCTION: Cytoreductive surgery (CRS) with concurrent hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment for colorectal peritoneal metastases (CPM) which can offer a median overall survival of 41 months and improve quality of life. Judicious patient selection is critical for deriving the greatest benefit and avoiding overtreatment. This meta-analysis identifies prognostic factors associated with survival in large cohorts derived from prospectively maintained databases of CRS-HIPEC patient cohorts. MATERIALS/METHODS: A systematic review and meta-analysis was conducted to evaluate prognostic variables influencing overall survival (OS) and disease-free survival (DFS) in patients with CPM who underwent CRS-HIPEC. RESULTS: Forty-five studies satisfied inclusion criteria for systematic review, with thirty-three studies included for qualitative synthesis. Incomplete cytoreduction, PCI, and grade III-IV complications were the strongest predictors of both OS and DFS. Tumour-specific factors associated with worse OS on pooled analysis included: poor differentiation, signet-ring cell pathology, nodal involvement, T4 stage, and rectal primary. Adjuvant/neoadjuvant systemic treatments had no significant impact on survival in this analysis. RAS mutations may be associated with poorer survival on exploratory analysis. CONCLUSION: Survival after CRS-HIPEC was best determined by quantity of peritoneal disease (PCI) and the ability to achieve complete cytoreduction (CC-0). Major post-operative complications impact survival beyond short term morbidity. Baseline primary tumour-specific features also impacted survival.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.