Cytoreductive surgery plus hyperthermic intraoperative peritoneal chemotherapy for people with peritoneal metastases from colorectal, ovarian or gastric origin: A systematic review of randomized controlled trials

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Summary of Clinical Trial Findings

Background

There is uncertainty about the benefits and risks of adding hyperthermic intraoperative peritoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) +/- systemic chemotherapy or systemic chemotherapy alone for peritoneal metastases from colorectal, gastric, or ovarian cancers.

Methods

Researchers searched for randomized controlled trials (RCTs) in medical literature until April 14, 2022 and used high-quality systematic review methods.

Findings

A total of eight RCTs were included, with seven RCTs used for quantitative analysis.
For gastric cancer, there is high uncertainty about the impact of CRS + HIPEC + systemic chemotherapy.
For stage III or greater epithelial ovarian cancer, CRS + HIPEC + systemic chemotherapy likely reduces all-cause mortality compared to CRS + systemic chemotherapy.
For colorectal cancer, CRS + HIPEC + systemic chemotherapy probably results in little to no difference in all-cause mortality and may increase serious adverse events proportions compared to CRS +/- systemic chemotherapy, but likely decreases all-cause mortality compared to fluorouracil-based systemic chemotherapy alone.

Interpretation

The role of CRS + HIPEC in gastric peritoneal metastases is uncertain.

CRS + HIPEC should be the standard of care in women with stage III or greater epithelial ovarian cancer undergoing interval CRS.

CRS + systemic chemotherapy should be the standard of care for people with colorectal peritoneal metastases, with HIPEC used only as part of an RCT focusing on subgroups and regimes.