ASO Reflections: Technical Success and Clinical Cost: Ethical Reflections on the Human Burden of CRS/HIPEC

PastCytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) sits at the intersection of technical complexity, oncologic ambition, and human vulnerability.As the field of peritoneal surface malignancies has matured, much of the literature has focused on indications, outcomes, and technique.1,2 Less attention has been paid to a difficult and central question: when should the surgeon decline to operate?This question is particularly relevant for surgeons early in their experience with peritoneal disease, when the desire to offer an aggressive treatment may outpace the discipline required for careful restraint.It is also of consequence for a field that continues to push the bounds of what is technically feasible and oncologically possible.Our article addressed this gap by examining CRS/HIPEC through the principles of autonomy, beneficence, non-maleficence, and justice, with particular attention to patient selection, informed consent, multidisciplinary decision-making, and quality of life.