Prophylactic Hyperthermic Intraperitoneal Chemotherapy in Locally Advanced Colorectal Cancer: Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis assessed prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for locally advanced colorectal cancer. It pooled data from nine studies involving 2023 patients: 553 received prophylactic HIPEC and 1470 were controls. HIPEC was associated with better peritoneal metastasis-free survival at one, three, and five years and better disease-free survival at three and five years. For three-year peritoneal metastasis-free survival, the hazard ratio was 0.333 (95% CI [0.152-0.731], P = 0.006). Overall survival and reported postoperative complications did not differ significantly between groups.

Key findings

• Peritoneal metastasis-free survival favored HIPEC at one year (HR 0.521, 95% CI [0.292-0.930], P = 0.028), three years (HR 0.333, 95% CI [0.152-0.731], P = 0.006), and five years (HR 0.334, 95% CI [0.125-0.887], P < 0.028).
• Disease-free survival favored HIPEC at three years (HR 0.701, 95% CI [0.574-0.855], P < 0.001) and five years (HR 0.714, 95% CI [0.590-0.864], P = 0.001).
• There was no statistically significant difference in overall survival, postoperative major complications, leakage, or surgical site complications.

Why it matters

Preventing peritoneal metastasis is a relevant goal in locally advanced colorectal cancer, and the pooled findings suggest prophylactic HIPEC may improve peritoneal metastasis-free and disease-free survival. The absence of a significant overall-survival difference means the reported disease-control benefits should not be assumed to translate into longer survival. The results may inform evaluation of this approach but do not establish its benefit conclusively.

What to keep in mind

The meta-analysis included nine studies, and the authors advise caution, calling for confirmation in future high-quality randomized studies and collaborative individual patient data meta-analyses.