Evolving Role of CRS and HIPEC: Current Indications

  • Firoz Rajan
  • Aditi Bhatt


Peritoneal surface oncology is a dynamic field. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an aggressive locoregional therapy that can prolong the life of selected patients with peritoneal metastases (PM). Initially, all sites of origin of PM were dealt with using the same prognostic variables, and the results were evaluated using the same parameters. Currently, PM secondary to various primary tumors or arising de novo from the peritoneum are dealt with individually with different indications, timing of CRS and HIPEC, and integration with other therapies. The indications may be considered fairly standardized. Though majority of these are supported by level 3 evidence that comprises of retrospective case series, these studies offer the most practical design for a situation where two radically different treatments (CRS and HIPEC versus systemic chemotherapy) need to be compared. Ongoing phase III trials in the therapeutic setting have been designed to compare CRS alone with CRS and HIPEC with or without other systemic therapies in various clinical scenarios. Like the role of surgery for nonmetastatic disease which has been established not by randomized controlled trials but through comparison with historical controls in most cancers, the role of CRS as a potentially curative treatment for selected patients with PM can be established based on the significant gain in survival over palliative therapies. It is the added benefit of HIPEC that is undefined in most conditions.

A significant proportion of patients treated with a curative intent develop recurrence, and reiterative CRS and HIPEC is being performed in selected patients with a good long-term survival and an acceptable morbidity. Another area of current research is the prevention of peritoneal spread in patients considered at risk for developing it, and the role of HIPEC in the prevention of PM is being evaluated in randomized controlled trials. The results of these trials my further expand the role of HIPEC. The introduction of newer therapies like pressurized intraperitoneal aerosol chemotherapy (PIPAC) that are also being evaluated in clinical trials could further modify the timing and indications for CRS and HIPEC.


Cytoreductive surgery HIPEC Indications Evidence-based indications Clinical trials 


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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Surgical OncologyKovai Medical CentreCoimbatoreIndia
  2. 2.Department of Surgical OncologyFortis Hospital BangaloreBangaloreIndia

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