Peritoneal Carcinomatosis: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Peritoneal carcinomatosis represents a heterogeneous group of malignancies in which local tumor burden, primary-site biology, and systemic disease behavior jointly determine prognosis. This critical narrative review examines the therapeutic contribution of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), with particular attention to patient selection and randomized evidence. PubMed/MEDLINE, full reports of pivotal trials, and international consensus documents available through 2026 were examined, prioritizing comparative survival, perioperative harms, and clinical applicability. Complete macroscopic cytoreduction is a central condition for meaningful disease control in suitable patients, but the benefit attributable to HIPEC is not uniform. In colorectal peritoneal metastases, PRODIGE 7 did not establish an overall survival advantage for short-duration oxaliplatin HIPEC, whereas the CAIRO6 trial did not support routine perioperative systemic chemotherapy for all resectable cases. In ovarian cancer, benefit appears most reproducible at interval cytoreduction, with more selective evidence in recurrence. Recent gastric trials found no survival benefit and substantial treatment burden. For pseudomyxoma peritonei and selected peritoneal mesothelioma, spe cialized CRS-HIPEC remains strongly supported by consensus despite low-certainty comparative evidence. Decisions should integrate resectability, disease distribution, expected morbidity, tumor-specific evidence, and patients' priorities.