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Meta-Analysis
. 2025 Jul;32(7):5063-5082.
doi: 10.1245/s10434-025-17321-w. Epub 2025 May 15.

Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) and Liver-Directed Therapy for Synchronous Peritoneal and Liver Metastatic Colorectal Cancer: A Systematic Review with Meta-analysis

Kadhim Taqi  1   2 , Simarpreet Icchhpuniani  3 , Cecily Stockley  4 , Golpira Elmi Assadzadeh  3 , Elijah Dixon  5 , Lloyd Mack  4   3 , Antoine Bouchard-Fortier  4   3
Affiliations
Meta-Analysis

Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) and Liver-Directed Therapy for Synchronous Peritoneal and Liver Metastatic Colorectal Cancer: A Systematic Review with Meta-analysis

Kadhim Taqi et al. Ann Surg Oncol. 2025 Jul.

Abstract

Introduction: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can improve survival in colorectal cancer (CRC) patients with peritoneal carcinomatosis (PC). The presence of synchronous liver metastases (LMs) often precludes patients from CRS/HIPEC; however, multiple studies suggest that CRS/HIPEC with liver-directed treatments may be beneficial. This systematic review examines outcomes and selection factors in CRC patients with PC and LM treated with CRS/HIPEC and liver-directed therapy.

Methods: A systematic review and meta-analysis was performed using the PubMed, EMBASE, and Web of Science databases from 2009 to 2024. The outcomes included patient selection factors, overall survival (OS) and disease-free survival (DFS).

Results: A total of 482 articles were retrieved, of which 17 retrospective studies met the inclusion criteria, comprising a total of 988 patients. Liver-directed therapy with CRS/HIPEC for PC and LM was associated with 3- and 5-year OS rates of 47% and 37%, respectively, with a median survival range of 15.3-47.6 months. The adjusted 1- and 3-year DFS rates were 34% and 23%, respectively, with a median DFS range of 6.2-29.4 months. Patients with PC and LM were more likely to have received preoperative systemic therapy (86%), undergone minor liver resection (90%), had a limited burden of LM (mean of three lesions, median size of 1.4-3 cm), and limited PC (mean peritoneal cancer index of 13).

Conclusion: This study indicates that CRS/HIPEC with liver-directed therapy can yield favorable survival outcomes for well-selected CRC patients with limited PC and LM. Further trials are needed to confirm its efficacy and refine optimal patient selection.

Keywords: CRS; Colorectal cancer; HIPEC; Liver resection; Peritoneal carcinomatosis; Survival.

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Conflict of interest statement

Disclosure: Kadhim Taqi, Simarpreet Icchhpuniani, Cecily Stockley, Golpira Elmi Assadzadeh, Elijah Dixon, Lloyd Mack, and Antoine Bouchard-Fortier declare no relevant affiliations or financial interests in the subject matter or materials discussed.

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