Clinical Corner - December 2022

One of the very “high tech” surgical procedures introduced over the last several decades, but gaining more importance in the last few years is Cytoreductive Surgery with the addition of Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). This approach has been used for treating intraperitoneal metastases resulting from ovarian, gastrointestinal and a variety of less common cancers. The concept of adding intraperitoneal chemotherapy after reducing obvious gross metastatic implants is based on the theory that the peritoneal/plasma barrier allows for high doses of drug, peritoneal clearance is less than systemic clearance and systemic toxicities may be reduced because of poor systemic absorption.

Recent clinical trials using CRS-HIPEC in managing colon cancer (Lancet Oncology, 2021) showed that complete cytoreduction alone may be as beneficial as adding an intraperitoneal instillation of chemotherapy. Most centers offering CRS-HIPEC are using tumor reduction and different chemotherapy regimens from those used in this trial. The important message for registrars is that this lengthy and involved surgical approach may be ongoing in your hospital where surgeons have been trained using this technique. These cases must be captured correctly by our registries using specific surgical codes to allow for outcomes of CRS-HIPEC to be assessed in the future.