Cytoreductive Surgery (CRS) and Hyperthermic IntraPeritoneal Chemotherapy (HIPEC): don’t throw the baby out with the bathwater

Results of the French randomized PRODIGE 7 trial presented this June at ASCO meeting show that adding Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) with oxalipatin to optimal cytoreductive surgery does not improve survival in peritoneal metastasis of colorectal origin [1]. A high dose of oxaliplatin (460mg/m body surface, equivalent to five times an intravenous dose) was applied and there was an increased risk of long-term complications. Clearly, given the lack of survival benefit and the increased risk of postoperative complications with HIPEC, incorporating intraperitoneal oxaliplatin-based chemotherapy into the standard treatment regimen for peritoneal metastatic colorectal cancer should be reconsidered. These results were object of intensive discussions among HIPEC surgeons during the last meeting of the Peritoneal Surface Oncology Group International (PSOGI) in Paris on September 9th–11th, 2018. In particular, following questions were raised: Is HIPEC beneficial for a subgroup of patients with a midrange peritoneal cancer index? Can people with a low peritoneal cancer index forgo HIPEC? Is 30minutes of HIPEC long enough? Do patients with a high index not benefit from either surgery or HIPEC? Which drug should be used in the future, if any? Is systemic chemotherapy necessary compared with CRS ?