Can Repeat Surgery Help Patients with Recurrent Colorectal Cancer That Has Spread to the Peritoneum?
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Oppat, K.M., Bennett, F.J., Patel, S.H. et al. Secondary Cytoreductive Surgery ± Hyperthermic Intraperitoneal Chemotherapy for Recurrent Colorectal Cancer Peritoneal Metastases. Ann Surg Oncol (2026). https://doi.org/10.1245/s10434-026-20255-6
Why was this study done?
For some people with colorectal cancer that has spread to the lining of the abdomen (called peritoneal metastases), treatment with cytoreductive surgery (CRS), with or without HIPEC (heated chemotherapy delivered directly into the abdomen), can improve survival. However, many patients experience a return of their cancer after treatment.
Doctors do not yet know whether a second CRS±HIPEC procedure is safe or whether it can help patients live longer. This study looked at outcomes for patients who underwent repeat surgery after their cancer returned.
What did the researchers do?
Researchers reviewed medical records from 12 high-volume cancer centers across the United States. They compared:
119 patients who had one CRS±HIPEC procedure, and
17 patients who later underwent a second CRS±HIPEC after their cancer came back.
The researchers looked at:
How safe repeat surgery was
Whether patients experienced serious complications
How long patients lived after treatment
What did the study find?
Repeat surgery was as safe as the first surgery.
Patients who underwent a second CRS±HIPEC had similar rates of:
Serious complications
Hospital readmissions
Length of hospital stay
Death within 30 days of surgery
These findings suggest that, in carefully selected patients, repeat surgery can be performed safely.
Patients who had repeat surgery lived longer.
When researchers looked only at patients whose cancer had returned, those who underwent a second CRS±HIPEC lived a median of 27 months, compared with 12 months for patients who were treated with systemic therapy and/or supportive care instead of another surgery.
Researchers also found that patients who underwent a second CRS±HIPEC had a survival benefit similar to what patients experienced after their first CRS±HIPEC procedure.
What are the limitations?
This study has several important limitations:
It was a retrospective study, meaning researchers looked back at existing medical records rather than conducting a clinical trial.
Only 17 patients underwent repeat surgery, making the study relatively small.
Patients who were healthy enough to undergo a second surgery may already have had less aggressive disease, which could have influenced the results.
Because of these limitations, the findings should be interpreted with caution.
What does this mean for patients?
This study suggests that a second CRS±HIPEC may be a reasonable option for carefully selected patients whose colorectal cancer returns only in the peritoneum. Repeat surgery did not appear to increase the risk of serious complications and was associated with longer survival compared with non-surgical treatment.
Not every patient will be a candidate for repeat surgery. Decisions about treatment should be made by an experienced multidisciplinary team that considers factors such as the location of the recurrence, overall health, and the likelihood that all visible disease can be removed. The authors also note that prospective clinical trials are still needed to better understand which patients are most likely to benefit from repeat CRS±HIPEC.
Key Takeaway
For carefully selected patients with recurrent colorectal cancer that has spread to the peritoneum, a second CRS±HIPEC procedure appears to be safe and may help patients live longer. While more research is needed, these findings support considering repeat surgery as a treatment option for some patients after discussion with an experienced peritoneal surface malignancy team.