Short-Term Effects of Hyperthermic Intraperitoneal Chemotherapy on Patients Following Cytoreductive Surgery: Retrospective Analysis From a Tertiary Care Center in Saudi Arabia

TL;DR

This study examines the short-term effects of combining surgery with heated chemotherapy in treating peritoneal cancer, finding no significant increase in complications.

Contribution

The study provides new insights into the short-term outcomes of HIPEC in Saudi Arabia, focusing on postoperative morbidity and mortality.

Findings

Patients receiving HIPEC had longer operative times and more frequent stoma creation.

Postoperative complications were fewer in the HIPEC group.

PCI was the only predictor of severe complications.

Abstract

Introduction

Cytoreductive surgery (CRS) with the use of hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for peritoneal surface malignancy. Increasing evidence demonstrates the survival benefit of CRS combined with HIPEC, with the completion of cytoreduction being a key factor in prognosis. This study aimed to evaluate the impact of HIPEC on short-term postoperative outcomes in patients undergoing CRS and to assess factors associated with postoperative morbidity.

Methods

This retrospective cohort study was conducted using a maintained database of patients with peritoneal surface malignancies who underwent CRS with and without HIPEC at a tertiary care center in Riyadh, Saudi Arabia, from January 1, 2021, to November 1, 2024.

Results

A total of 95 patients were included, 52 of whom underwent CRS alone and 43 received CRS combined with HIPEC. Demographic and clinical characteristics were largely similar between groups; however, patients who underwent CRS and HIPEC had higher preoperative albumin levels (p = 0.007) and more frequent previous surgeries (p = 0.020). Operative time was significantly longer in the CRS and HIPEC group (p < 0.001), and stoma creation was more common (p = 0.014). Overall, postoperative complications were fewer in the CRS and HIPEC group. The 30-day mortality rate was 0% for both groups, and the Peritoneal Cancer Index (PCI) was the only predictor of severe complications (p = 0.047).

Conclusion

Complete cytoreduction remains the standard in the treatment of peritoneal surface malignancies to maximize survival potential. The addition of HIPEC does not appear to increase short-term postoperative outcomes, while disease burden, as reflected by the PCI, remains the primary independent determinant of postoperative risk.