[Value and controversy of prophylactic hyperthermic intraperitoneal chemotherapy in locally advanced colorectal cancer]

Locally advanced colorectal cancer patients are characterized by poor prognosis and high recurrence rates, with peritoneal metastasis rates as high as 20%-30%. Despite curative resection and chemotherapy being the main treatment methods, challenges remain in preventing peritoneal metastasis. Neoadjuvant therapy and immunotherapy are hot topics of research, and hyperthermic intraperitoneal chemotherapy (HIPEC) is one of the new approaches for preventing peritoneal metastasis, yet its value and safety are still controversial. HIPEC can directly target free tumor cells in the abdominal cavity through hyperthermic effects and high concentrations of chemotherapeutic drugs, but its prophylactic use requires further exploration regarding effectiveness and risks. Early intervention and identification of high-risk factors are crucial for improving therapeutic outcomes, and tests such as circulating tumor DNA and free peritoneal cell DNA provide new avenues for early screening. The value of prophylactic HIPEC varies across different studies, and its complications and risks should not be overlooked. The selection of chemotherapy drugs, dosage, and personalized treatment plans are key factors affecting therapeutic efficacy. Other prevention strategies, such as pressurized intraperitoneal aerosol chemotherapy and neoadjuvant chemotherapy, are also being explored. In summary, prophylactic HIPEC shows some potential in controlling peritoneal metastasis, but its application requires individualized assessment and optimization.