Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 17;17(12):2014.
doi: 10.3390/cancers17122014.

Iterative Cytoreductive Surgery and HIPEC for Peritoneal Metastases from Primary Appendiceal and Colorectal Cancers: An Observational Study

Andrew M Fleming  1 , Owen M Clark  1 , Jaewon J Lee  2 , Kristen Dougherty  2 , Leah E Hendrick  3 , Jordan Raine  4 , Ian Solsky  1 , Paxton V Dickson  1 , Evan S Glazer  1 , David Shibata  1 , Elizabeth Gleeson  2 , Gitonga Munene  5 , Jeremiah L Deneve  2
Affiliations

Iterative Cytoreductive Surgery and HIPEC for Peritoneal Metastases from Primary Appendiceal and Colorectal Cancers: An Observational Study

Andrew M Fleming et al. Cancers (Basel). .

Abstract

Background: Peritoneal relapse after cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is common. Repeat CRS/HIPEC offers the potential for long-term survival in the appropriately selected patient. Methods: We performed a retrospective review of a single institution database to assess perioperative outcomes after repeat CRS/HIPEC for appendiceal (pAC) and colorectal (pCRC) cancers. Kaplan-Meier and Cox estimates were used to assess survival. Results: Of 157 patients, 103 patients underwent initial CRS/HIPEC for pAC (n = 67) or pCRC (n = 36) histologies. Twenty-seven pAC patients (27/67, 40%) and 23/36 pCRC patients (63%) developed disease recurrence. Relapsed patients had a higher burden of disease (PCI), operative length and blood loss and received adjuvant chemotherapy (all p < 0.05). Nine of the 27 relapsed pAC patients and 5 of the 13 relapsed pCRC patients underwent repeat CRS/HIPEC. The median time to repeat CRS/HIPEC was 18 months (4-26 months), and a CCR-0 and CCR-1 were achieved in 79% and 21%, respectively. The 1-, 3- and 5-year OS for pAC patients who underwent repeat CRS/HIPEC was 88.9%, 88.9% and 77.8%, and the 1- and 3-year OS for pCRC patients was 100% and 25%, respectively. Repeat CRS/HIPEC for pAC was associated with significant improvement in OS (p = 0.03), while for pCRC, no significant difference was observed (p = 0.99). Conclusions: Repeat CRS/HIPEC for isolated peritoneal recurrence is safe and offers the potential for long-term survival. Patient selection is key to ensure optimal cytoreduction when considering repeat CRS/HIPEC.

Keywords: CRS/HIPEC; HIPEC; cytoreduction; peritoneal carcinomatosis; recurrence; repeat.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection flow diagram.
Figure 2
Figure 2
(A) Forest plot of overall survival in patients with disease relapse after index HIPEC for metastatic carcinoma of the appendix. (B) Overall survival in patients with metastatic carcinoma of the appendix treated with CRS/HIPEC, stratified by disease relapse and implementation of repeat CRS/HIPEC. (C) Forest plot of overall survival in patients with disease relapse after index HIPEC for metastatic carcinoma of the colon. (D) Overall survival in patients with metastatic carcinoma of the colon treated with CRS + HIPEC, stratified by disease relapse and implementation of repeat CRS/HIPEC. pAC = peritoneal metastases of appendiceal primary; pCRC = peritoneal metastases of colorectal primary; CRS = cytoreductive surgery; HIPEC = hyperthermic intraperitoneal chemotherapy; PCI = peritoneal carcinomatosis index; EBL = estimated blood loss; PRBC = packed red blood cells.
Figure 3
Figure 3
(A) Overall survival in patients with recurrent pAC not undergoing repeat CRS/HIPEC, stratified by grade. (B) Overall survival in patients with low-grade pAC, stratified by presence or absence of disease recurrence and receipt of repeat CRS/HIPEC. (C) Overall survival of patients with non-signet ring histology pAC, stratified by presence or absence of disease recurrence and receipt of repeat CRS/HIPEC. pAC = peritoneal metastases of appendiceal primary; pCRC = peritoneal metastases of colorectal primary; CRS = cytoreductive surgery; HIPEC = hyperthermic intraperitoneal chemotherapy.
See this image and copyright information in PMC

References

    1. Levine E.A., Stewart J.H., Shen P., Russell G.B., Loggie B.L., Votanopoulos K.I. Intraperitoneal chemotherapy for peritoneal surface malignancy: Experience with 1000 patients. J. Am. Coll. Surg. 2014;218:573–585. doi: 10.1016/j.jamcollsurg.2013.12.013. - DOI - PMC - PubMed
    1. Chua T.C., Moran B.J., Sugarbaker P.H., Levine E.A., Glehen O., Gilly F.N., Baratti D., Deraco M., Elias D., Sardi A., et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J. Clin. Oncol. 2012;30:2449–2456. doi: 10.1200/JCO.2011.39.7166. - DOI - PubMed
    1. Verwaal V.J., Bruin S., Boot H., van Slooten G., van Tinteren H. 8-year follow-up of randomized trial: Cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann. Surg. Oncol. 2008;15:2426–2432. doi: 10.1245/s10434-008-9966-2. - DOI - PubMed
    1. Verwaal V.J., Boot H., Aleman B.M.P., van Tinteren H., Zoetmulder F.A.N. Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: Location, treatment, and outcome. Ann. Surg. Oncol. 2004;11:375–379. doi: 10.1245/ASO.2004.08.014. - DOI - PubMed
    1. Bijelic L., Yan T.D., Sugarbaker P.H. Treatment failure following complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from colorectal or appendiceal mucinous neoplasms. J. Surg. Oncol. 2008;98:295–299. doi: 10.1002/jso.21084. - DOI - PubMed

LinkOut - more resources