Patients with peritoneal metastases from primary cancers, such as appendiceal, ovarian, gastric, mesothelioma, and colon cancer, may benefit from cytoreduction (CRS) and intraoperative heated intraperitoneal chemotherapy (HIPEC). The indications for CRS-HIPEC are unique for each disease type and the volume of disease, but in general have been shown to improve survival for well-selected patients. Data supporting CRS-HIPEC is also different for each disease, ranging from randomized clinical trials showing an overall survival benefit for the addition of HIPEC in patients with ovarian cancer to primarily retrospective data for appendiceal cancer.
1‐6 CRS-HIPEC is now considered the standard of care for appendiceal cancer and pseudomyxoma peritonei based on a comparison of modern cohorts compared to historical controls of patients who underwent debulking surgery alone. While innovation abounds in the arena of peritoneal surface malignancies (PSM), from organoid research to peptide vaccines and the rapid expansion of pressurized intraperitoneal aerosolized chemotherapy (PIPAC) worldwide, the ability to perform surgical trials continues to present major challenges in the clinical realm.
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