Cytoreductive Surgery and Intraperitoneal Chemotherapy in Peritoneal Malignancies

Cytoreductive surgery (CRS) combined with intraperitoneal chemotherapy (IPC) has emerged as a cornerstone in the management of peritoneal malignancies, offering a locoregional approach that directly targets tumour deposits within the peritoneal cavity. The procedure begins with meticulous surgical removal of macroscopic disease, aiming for no visible residual tumour, followed by the administration of chemotherapy into the peritoneal space. Variants of IPC include hyperthermic intraperitoneal chemotherapy (HIPEC), which employs heated chemotherapeutic solutions to enhance drug penetration and cytotoxicity, and pressurised intraperitoneal aerosol chemotherapy (PIPAC), which delivers aerosolised drugs under pressure to improve peritoneal distribution. Patient selection hinges on disease extent, performance status and absence of extraperitoneal metastases, often quantified using the Peritoneal Carcinomatosis Index (PCI). Complete cytoreduction correlates strongly with prolonged survival across colorectal, gastric, ovarian and appendiceal primaries. Technological refinements in perfusion circuits, temperature control and aerosol generators have optimised pharmacokinetics, minimised systemic toxicity and facilitated repeated applications. Recent advances include novel drug carriers such as thermosensitive hydrogels and compartmentalised immunomodulatory agents, which aim to overcome limitations of clearance and enhance antitumour immunity. As centres accrue experience, perioperative morbidity and mortality rates have fallen, positioning CRS and IPC among accepted high-risk oncological procedures. Ongoing efforts focus on integrating systemic and regional therapies, refining biomarkers for response assessment and expanding indications to include prophylactic adjuvant applications in high-risk primary tumours. Collectively, CRS and IPC represent a paradigm shift in treating peritoneal surface malignancies, transforming a uniformly fatal condition into one amenable to long-term control in selected patients.

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Cytoreductive Surgery and Intraperitoneal Chemotherapy in Peritoneal Malignancies publication trend

The graph below shows the total number of articles in cytoreductive surgery and intraperitoneal chemotherapy in peritoneal malignancies across all publications each year (not limited to Nature Index journals).

Technical terms

Cytoreductive Surgery (CRS): Surgical removal of visible tumour nodules within the peritoneal cavity to achieve macroscopic clearance.

Intraperitoneal Chemotherapy (IPC): Administration of cytotoxic agents directly into the peritoneal space to maximise local drug concentration and minimise systemic exposure.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC): IPC performed with heated chemotherapeutic solution (typically 41–43 °C) to increase tumour cell susceptibility and drug penetration.

Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC): Delivery of aerosolised chemotherapy under pressure to enhance peritoneal distribution and tissue uptake.

Peritoneal Carcinomatosis Index (PCI): Quantitative scoring system (0–39) that assesses tumour burden in 13 abdominal regions to guide treatment planning and prognostication.

References

1. Enhanced Chemo‐Immunotherapy Strategy Utilizing Injectable Thermosensitive Hydrogel for The Treatment of Diffuse Peritoneal Metastasis in Advanced Colorectal Cancer. Advanced Science (2023).
2. The multivisceral landscape of colorectal cancer metastasis: implications for targeted therapies. Journal of Clinical Investigation (2024).
3. Intraperitoneal Chemotherapy of Peritoneal Carcinomatosis Using Pressurized Aerosol as an Alternative to Liquid Solution: First Evidence for Efficacy. Annals of Surgical Oncology (2013).
4. Morbidity and Mortality Rates Following Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy Compared With Other High-Risk Surgical Oncology Procedures. JAMA Network Open (2019).
5. Survival After Hyperthermic Intraperitoneal Chemotherapy and Primary or Interval Cytoreductive Surgery in Ovarian Cancer. JAMA Surgery (2022).
6. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial. BMC Cancer (2015).