e15549 Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis has been a contentious issue due to concerns regarding its oncologic efficacy weighed against high surgical complication rates. The present retrospective analysis aims to reappraise the clinical and surgical outcomes in these patients. Methods: Patients with pathologically confirmed colorectal adenocarcinoma and clinical peritoneal carcinomatosis who underwent cytoreductive surgery with HIPEC were retrospectively included. The exclusion criteria were: (1) repeat HIPEC procedures; and (2) an American Society of Anesthesiologists (ASA) score ≥4. Patients were stratified according to the Completeness of Cytoreduction (CC) score (CC-0, CC-1, CC-2). Major complications were defined as Clavien-Dindo grade ≥3. Surgical efficacy and complications were compared among the groups. Results: Between 2015 and 2025, a total of 142 patients were included. The median follow-up was 17.2 months (range: 0.5–111.9). The overall complication rate was 48.6%, with a major complication (Clavien-Dindo grade ≥3) rate of 21.1%. When stratified by Completeness of Cytoreduction (CC) score, median overall survival (OS) was not reached (NR) for CC-0, 18.4 months (95% CI: 10.8-77.0) for CC-1, and 7.1 months (95% CI: 1.1-69.6) for CC-2 (p = 0.0002). The 5-year OS rate for the CC-0 group was 61.5% (95% CI: 47.5–72.8%). Major complication rates differed significantly among the groups (CC-0: 12.6%, CC-1: 31.6%, CC-2: 41.2%; p = 0.0057). Further analysis was performed according to PCI thresholds: 24. In the high-PCI subgroup ( > 24, n = 24), CC-0 was achieved in only 4.2% (1/24), compared to 58.3% for CC-1 and 37.5% for CC-2. In this challenging setting, the median OS for the three groups was NR, 18.8 (95% CI: 10.1-26.9), and 17.3 months (95% CI: 6.4-NA), respectively (p < 0.0001) with major complication rates of 15.4%, 26.0%, and 37.5% (p = 0.4572). The 5-year OS rate for the PCI < 12 group was 67.6% (95% CI: 54.1–77.8%). Conclusions: The present study confirms the significant clinical efficacy and acceptable complication rates for patients undergoing cytoreductive surgery with HIPEC for colorectal cancer with peritoneal carcinomatosis. We advocate that this treatment is worthy of recommendation for selected patients, even in cases with high PCI scores.
Hsu et al. (Thu,) studied this question.