This is a combined treatment for peritoneal carcinomatosis: first cytoreductive surgery (CRS) — complete removal of visible disease — then HIPEC, infusion of heated chemotherapy into the abdomen. It is for selected patients and is decided at a tumour board.
What is CRS/HIPEC?
It is a specialised, combined treatment of peritoneal carcinomatosis in selected patients. It has two components: cytoreductive surgery (CRS) — surgical removal of all visible disease — and, immediately after, hyperthermic intraperitoneal chemotherapy (HIPEC) to eliminate microscopic residual disease.
Cytoreduction includes, as needed, peritonectomy procedures and organ resections, aiming for no visible residual disease (CC-0/CC-1) — the strongest prognostic factor.
When is it needed?
It is indicated for peritoneal spread of selected extent from colorectal/appendiceal cancer (especially pseudomyxoma peritonei), peritoneal mesothelioma, and selected ovarian or gastric cancers.
Suitability is strictly judged by a multidisciplinary team based on disease extent (the PCI), the feasibility of complete cytoreduction, and the patient's general condition.
Preparation
Extensive staging is required (CT/MRI, often diagnostic laparoscopy to assess the PCI), optimisation of nutrition and organ reserve, and detailed counselling about the scale of surgery. Planning is done at a specialist centre.
How it's done
In the cytoreduction component, every visible focus is systematically removed with peritonectomies and, where needed, organ resections, to achieve complete cytoreduction. HIPEC follows: circulating a hyperthermic chemotherapy solution in the peritoneal cavity for a set time to treat microscopic disease with high local concentration and limited systemic toxicity.
It is a long, demanding operation performed by a specialist team.
Cytoreduction (CRS)
Systematic surgical removal of all visible peritoneal disease — the completeness determines the outcome.
HIPEC
Infusion of heated chemotherapy into the abdomen for microscopic residual disease, right after cytoreduction.
Tumour board
Patient selection and strategy are decided multidisciplinarily, at a specialist centre.
Recovery
Recovery is longer than a standard resection: usually initial ICU/high-dependency monitoring and a hospital stay of several days to weeks, depending on extent. Eating and mobilisation return gradually.
Subsequent oncological strategy and follow-up are decided by the multidisciplinary team.
Risks & outcomes
As an extensive operation, it carries higher perioperative morbidity: anastomotic leaks, infections, haematological toxicity from the chemotherapy, prolonged ileus. Strict patient selection and centre experience are decisive for safety and outcome.
In appropriately selected patients, complete cytoreduction with HIPEC can offer meaningful oncological benefit.
Frequently asked questions
Which patients is it for?
For carefully selected patients with limited peritoneal disease, where complete cytoreduction is judged feasible. The decision is always made at a tumour board.
What is PCI?
It is an index that quantifies the extent of peritoneal disease. It helps assess suitability for CRS/HIPEC and prognosis.
How long is recovery?
It is a major operation with a prolonged stay and a gradual, individualised recovery, with close monitoring.
Is it curative?
In selected patients it can offer substantial oncological benefit and, in certain conditions, long-term disease control. The outcome depends on the tumour type and the completeness of cytoreduction.