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Prophylactic HIPEC improves peritoneal metastasis-free survival and disease-free survival in locally advanced colorectal cancerHIPEC treatment shows promise for advanced colorectal cancer patients

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Key Takeaway
Consider prophylactic HIPEC as a potential intervention to improve metastasis-free and disease-free survival in these patients.

This meta-analysis evaluated the efficacy of prophylactic Hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with locally advanced colorectal cancer. The analysis synthesized data from 2023 cases to assess primary and secondary outcomes related to survival and surgical complications.

Key findings indicate that prophylactic HIPEC significantly improved peritoneal metastasis-free survival at one year (HR 0.521; 95% CI 0.292-0.930; P = 0.028), three years (HR 0.333; 95% CI 0.152-0.731; P = 0.006), and five years (HR 0.334; 95% CI 0.125-0.887; P < 0.028). Additionally, disease-free survival was significantly improved at three years (HR 0.701; 95% CI 0.574-0.855; P < 0.001) and five years (HR 0.714; 95% CI 0.590-0.864; P = 0.001).

No statistically significant differences were observed regarding overall survival or postoperative complications, including leakage and surgical site complications. The authors note that these findings should be interpreted cautiously. They emphasize the need for confirmation through future high-quality randomized studies and collaborative individual patient data meta-analyses. Clinical application is currently limited by the need for more robust evidence to confirm the association between HIPEC and improved survival outcomes.

How this fits prior evidence

This meta-analysis addresses a gap in treatment options for locally advanced colorectal cancer by evaluating the role of prophylactic HIPEC. While previous coverage identified biomarkers such as ANXA1 dominance as a prognostic indicator for recurrence and noted that SCRT-based TNT improves pathological complete response but not survival, this study specifically focuses on the survival outcomes of HIPEC. The finding of improved disease-free survival and metastasis-free survival provides a specific intervention-based outcome for this patient population.

When cancer spreads within the abdomen, it becomes much harder to treat. For people living with locally advanced colorectal cancer, doctors are looking for ways to stop the disease from spreading to the lining of the abdominal cavity. A large review of data involving over 2,000 patients looked at a specific treatment called prophylactic HIPEC.

This treatment involves using heated chemotherapy directly in the abdomen. The study found that patients who received this method had better survival rates without the cancer spreading to the abdomen at the one, three, and five-year marks. It also showed better disease-free survival over five years compared to the group that did not receive it.

While the results for spreading and staying cancer-free were positive, the study did not find a significant difference in overall survival or the rate of surgical complications. Because these findings come from a meta-analysis, experts suggest looking at future high-quality trials to confirm these results before making major changes to standard care.

What this means for you:
HIPEC treatment may help prevent cancer from spreading in the abdomen for some colorectal cancer patients.

Common questions

What is HIPEC and how does it work?

HIPEC stands for Hyperthermic intraperitoneal chemotherapy. It is a treatment where heated chemotherapy is delivered directly into the abdominal cavity. This method is used to target cancer cells in the area and may help prevent the cancer from spreading to the lining of the abdomen.

Does HIPEC make surgery more dangerous?

The study found no statistically significant difference in postoperative major complications, leakage, or surgical site complications between the group that received HIPEC and the control group. This suggests the procedure did not increase the risk of common surgical issues in the patients studied.

How much better does HIPEC help with cancer spread?

Patients receiving HIPEC showed better peritoneal metastasis-free survival at one, three, and five years. Specifically, the risk of cancer spreading was significantly lower in the HIPEC group at the three-year mark (HR 0.333) and the five-year mark (HR 0.334).

Study Details

Study typeMeta analysis
Sample sizen = 2,023
EvidenceLevel 1
Follow-up36.0 mo
PublishedNov 2026
View Original Abstract ↓
BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be effective to treat peritoneal carcinomatosis (PM). However, the benefits of prophylactic HIPEC in patients with locally advanced colorectal cancer remains unknown. This meta-analysis aimed to determine the impact of prophylactic HIPEC in this setting. METHODS: We performed a systematic literature review using PubMed, Embase, and Web of Science databases according to pre-defined inclusion and exclusion criteria. Oncological parameters were extracted and pooled to analyze peritoneal metastasis-free survival, disease-free survival, and overall survival. RESULTS: We included 2023 patients (1470 in the control group and 553 in the prophylactic HIPEC group) originating from nine studies. One-year, 3-year, and 5-year peritoneal metastasis-free survival, 3-year and 5-year disease-free survival were better in the prophylactic HIPEC group than in the control group (hazard ratio [HR] 0.521, 95% confidence interval [CI] [0.292-0.930], P = 0.028; HR 0.333, 95% CI [0.152-0.731], P = 0.006; HR 0.334, 95% CI [0.125-0.887], P < 0.028; HR 0.701, 95% CI [0.574-0.855], P < 0.001; HR 0.714, 95% CI [0.590-0.864], P = 0.001), respectively. There was no statistically significant difference in overall survival, postoperative major complications, leakage, or surgical site complications between groups. CONCLUSIONS: While prophylactic HIPEC appears to improve peritoneal metastasis-free survival and disease-free survival, the findings should be interpreted cautiously and require confirmation through future high-quality randomized studies and collaborative individual patient data meta-analyses.
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