Comparing the safety of surgery options for patients with peritoneal metastasis

This study investigated the safety of hyperthermic intraperitoneal chemotherapy (HIPEC) and surgery in colon cancer patients with peritoneal metastasis (PM). Researchers reported that HIPEC and surgery was associated with an increased risk of complications.

When colon cancer spreads to the abdominal lining (known as peritoneal metastasis or PM), intensive treatment is often needed early on. Some patients with PM are able to undergo cytoreductive surgery (CRS), a specialized type of surgery aimed to remove as much as possible of the tumor. Previous studies have reported a survival benefit when CRS is combined with hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC involves heated chemotherapy drugs delivered directly to the affected area during surgery. However, CRS plus HIPEC is also associated with a number of side effects. More studies are needed to examine the safety of this treatment combination.

The aim of this study was to examine the safety of HIPEC plus CRS for colon cancer patients with PM.

The records of 371 colon cancer patients treated with conventional colon surgery were analyzed. Of these, 43 patients underwent additional treatment with CRS plus HIPEC. All patients treated with CRS and HIPEC had PM.

Complications after surgery were observed in 69.8% of patients treated with CRS and HIPEC. This was significantly higher compared to patients treated with surgery alone (40.5%). Severe complications were observed in 23.3% of patients receiving the additional treatment compared to 14.9% of patients treated with surgery alone. Overall, the risk of experiencing complications after surgery was 6.43 times higher for patients treated with CRS and HIPEC.

None of the HIPEC patients died within the 30 days after the procedure compared to 11 patients treated with surgery alone. The average hospital stay was 11 days in the CRS plus HIPEC group. This was significantly longer compared to patients treated with surgery alone (7 days). Significantly more patients receiving the additional treatment had to be readmitted to hospital (20.9%) compared to patients treated with surgery alone (6.4%).

Researchers concluded that outcomes after surgery were worse for patients treated with CRS and HIPEC. 

Only 3.4% of patients in the group treated with surgery alone had PM compared to 100% of patients receiving the additional treatment. Patients treated with CRS and HIPEC therefore had less favorable cancer markers even before the procedure. Larger studies that randomly assign PM patients to treatment groups are needed to confirm these findings.