Evaluation of the Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) on Long-Term Survival and Morbidity Profile: A Systematic Review of the Peritoneal Carcinomatosis Management

Peritoneal carcinomatosis (PC) has historically represented a terminal stage of abdominal malignancies, with median survival rarely exceeding 6-12 months when managed with systemic chemotherapy alone. Cytoreductive surgery (CRS), combined with hyperthermic intraperitoneal chemotherapy (HIPEC), has emerged as a locoregional therapeutic strategy designed to eradicate both macroscopic and microscopic peritoneal disease. The impact of this combined modality on long-term survival and its related morbidity profile is critically reviewed in this systematic review. A Preferred Reporting Items for Systematic reviews and Meta-Analyses-guided search of PubMed, Scopus, Web of Science, and Embase identified 15 high-quality studies (two randomized controlled trials and 13 cohort studies) comprising 3,247 patients. The synthesis of evidence has proven that the treatment CRS+HIPEC gives a significant survival advantage in carefully selected patients. The median overall survival increased significantly: 30-63 months for colorectal PC, 45-68 months for ovarian PC, and frequently more than 100 months for low-grade appendiceal malignancies, whereas with palliative systemic therapy, it was 12-24 months. However, this benefit is accompanied by considerable morbidity, with significant (Clavien-Dindo III-IV) major complications occurring in 20%-50% and procedure-related mortality occurring in 1%-5%. Survival is largely determined by completeness of cytoreduction (CC-0/1), a Peritoneal Cancer Index below critical thresholds (which vary by tumor type: typically <20 for colorectal, <10-15 for gastric, and higher thresholds for appendiceal tumors), and primary tumor biology. The evidence highlights the fact that CRS+HIPEC is a high-risk, high-reward intervention. Its successful implementation requires rigorous patient selection in high-volume, multidisciplinary centers using standardized protocols that will maximize survival with minimization of significant perioperative risks.