Oncological Outcomes After Cytoreductive Surgery and HIPEC for Colorectal and Appendiceal Peritoneal Metastases: A Retrospective Cohort Study

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ID: 315741
2026
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Abstract
Abstract Background Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for peritoneal metastases from colorectal cancer (PM-CRC) and appendiceal tumors, with favorable outcomes reported in pseudomyxoma peritonei. However, oncological outcomes vary by tumor entity and disease burden. Aims This study aimed to evaluate oncological outcomes and identify prognostic factors for cancer-specific survival (CSS) and disease-free survival (DFS) following CRS/HIPEC for PM-CRC and appendiceal peritoneal metastases. Methods This retrospective single-center cohort study included 135 patients treated with CRS/HIPEC for PM-CRC or metastatic appendiceal tumors, including low- and high-grade appendiceal mucinous neoplasms (LAMN, HAMN) and appendiceal carcinoma (AC), between 2014 and 2024. Primary endpoints were CSS and DFS; secondary endpoints included postoperative morbidity and major complications. Survival was analyzed using the Kaplan-Meier method with log-rank testing for comparison between tumor entities. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models. Results The cohort comprised 37 LAMN, 4 HAMN, 28 AC and 67 PM-CRC patients. Complete cytoreduction (CC-0/1) was achieved in 93% of cases. Median peritoneal cancer index was 11. The median overall survival was not reached for LAMN and HAMN, was 57.9 months for AC, and 31.4 months for PM-CRC, with significant differences between tumor entities (p<0.001). Positive lymph node status was associated with reduced CSS (HR 4.61, 95% CI 2.31-9.22; p<0.001) and DFS (HR 3.84, 95% CI 2.29-6.46; p<0.001). Small bowel resection was associated with reduced CSS (HR 1.79, 95% CI 1.02-3.09; p=0.04) and DFS (HR 1.75, 95% CI 1.11-2.77; p=0.02). Incomplete cytoreduction was associated with shorter CSS (HR 2.43, 95% CI 1.14-5.15; p=0.02). Conclusion CRS/HIPEC provides favorable long-term outcomes in selected patients with peritoneal metastases, particularly those with appendiceal tumors. Tumor entity, lymph node status, completeness of cytoreduction, and small bowel resection significantly influence oncological outcomes, emphasizing the importance of careful patient selection.
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Authors S Hügli, A Anranter, S Suter, D Eshmuminov, P Kron, J Oberholzer, P Limani
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag055.083
URL
https://doi.org/10.1093/bjs/znag055.083
Keywords Keywords not found

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