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Updated: Apr 7, 2026
Thermal Ablation for the Treatment of Abdominal Tumors
Published on: March 7, 2011
Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center
Yaniv Berger1, Samantha Aycart1, John P Mandeli2
1Department of Surgery, Division of Surgical Oncology, Mount Sinai Medical Center, New York, NY, USA.
Insights
Extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) involving many organs increases complications and worsens survival, especially for colorectal cancer patients. Less extensive CRS/HIPEC offers better outcomes.
Area of Science:
- Surgical Oncology
- Oncologic Outcomes
- Cytoreductive Surgery
Background:
- Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may necessitate multivisceral resection for optimal debulking.
- Assessing outcomes of extensive CRS/HIPEC procedures is crucial for patient management.
Purpose of the Study:
- To evaluate perioperative and long-term outcomes of extreme cytoreduction within CRS/HIPEC.
- To compare outcomes between patients undergoing extreme versus less extensive CRS/HIPEC.
Main Methods:
- Retrospective review of patients undergoing CRS/HIPEC from March 2007 to July 2014.
- Comparison of "extreme" cytoreduction (≥5 organs or ≥3 bowel anastomoses, n=50) with less extensive procedures (n=219).
Main Results:
- Complete cytoreduction achieved in 76% of the extreme CRS/HIPEC group.
- Extreme CRS/HIPEC group had higher PCI, blood loss, surgery duration, and hospital stay (p<0.001).
- Major 30-day morbidity (34% vs 17.4%, p=0.008) and 90-day mortality trend (12% vs 5.1%, p=0.07) were higher in the extreme group. Colorectal cancer patients undergoing extreme CRS/HIPEC had poorer disease-free and overall survival (p<0.01).
Conclusions:
- Extreme multivisceral resection in CRS/HIPEC is linked to increased major morbidity and worse oncologic results.
- CRS/HIPEC yields optimal outcomes when fewer organs are involved.
Background:
Multivisceral resection as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may be required in order to achieve optimal debulking. This study aimed to assess perioperative and long-term outcomes of the most extensive CRS/HIPEC procedures.
Methods:
All patients who underwent CRS/HIPEC at our institution between March 2007 and July 2014 were retrospectively reviewed. Patients undergoing extreme cytoreduction (n = 50), defined as a resection of ≥5 organs or ≥3 bowel anastomoses, were compared with patients who underwent less extensive procedures (n = 219).
Results:
Complete cytoreduction (CC score ≤1) was achieved in 76% of the extreme CRS/HIPEC group, which included patients with colorectal cancer (CRC, n = 17), appendiceal adenocarcinoma (n = 20), gastric cancer (n = 6), and low-grade appendiceal neoplasm (n = 3). When compared with other patients undergoing CRS/HIPEC, the extreme CRS/HIPEC group had higher median PCI score, increased intraoperative blood loss, longer duration of surgery and longer hospital stay (all p values < 0.001). Major 30-day morbidity was significantly higher among the extreme CRS/HIPEC group (34% vs. 17.4%, p = 0.008) and there was also a trend towards higher 90-day mortality (12% vs. 5.1%, p = 0.07). Median disease free survival and overall survival in CRC patients undergoing extreme CRS/HIPEC was poorer (4.1 vs. 14.3 months, p = 0.01 and 10.1 vs. 43.8 months, p < 0.001, respectively). Extreme CRS/HIPEC was found to independently predict decreased overall survival in CRC patients.
Conclusions:
Extreme multivisceral resection as part of CRS/HIPEC is associated with higher major morbidity and inferior oncologic outcomes; therefore CRS/HIPEC provides the best outcomes in patients with fewer organs involved.
