Could CRS-HIPEC Help Some Patients with Pancreatic Cancer That Has Spread to the Peritoneum?
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Ribeiro T, Rebelo P, Rangelova E ...Impact of cytoreductive surgery with HIPEC in the treatment of pancreatic cancer with peritoneal carcinomatosis: A systematic review
European Journal of Surgical Oncology, 2026; 52
What was this study about?
Pancreatic cancer that has spread to the lining of the abdomen (called the peritoneum) is often difficult to treat and is associated with poor outcomes. Standard treatment typically involves chemotherapy, but survival rates remain low.
Researchers conducted a systematic review to examine whether a treatment approach called cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may improve outcomes for some patients with pancreatic cancer and peritoneal metastases.
CRS involves surgically removing as much visible cancer as possible. HIPEC is a heated chemotherapy treatment delivered directly into the abdominal cavity during surgery to target any remaining cancer cells.
What did the researchers find?
The review analyzed three studies involving 39 patients who underwent CRS-HIPEC for pancreatic cancer that had spread to the peritoneum.
Key findings included:
Patients who received CRS-HIPEC lived a median of 12 to 26 months after surgery.
In the only study that compared treatments, patients who received CRS-HIPEC lived a median of 41 months from diagnosis, compared with 19 months for patients who received chemotherapy alone.
Patients whose surgeons were able to remove all visible cancer (known as a complete cytoreduction or CC-0 resection) had better outcomes than those with remaining visible disease.
In one study, patients who achieved complete cytoreduction experienced a median of 17 months without disease progression, compared with about 5 months for patients with incomplete tumor removal.
Why is this important for patients?
These findings suggest that CRS-HIPEC may offer a survival benefit for a carefully selected group of patients with pancreatic cancer that has spread only to the peritoneum.
The treatment may be most beneficial for patients who:
Have a limited amount of cancer spread within the abdomen
Respond well to chemotherapy before surgery
Are healthy enough to undergo a major operation
Are expected to have all visible cancer removed during surgery
For some patients, CRS-HIPEC may also provide a period of time without the need for ongoing chemotherapy, which could improve quality of life.
Are there risks?
Yes. CRS-HIPEC is a complex procedure that can cause serious complications.
Across the studies reviewed:
Major complications occurred in 20% to 43% of patients.
Deaths related to surgery occurred in 0% to 16.7% of patients, although these numbers came from very small studies.
Because of these risks, CRS-HIPEC should only be considered at experienced centers with expertise in treating peritoneal cancers.
What are the limitations of this research?
While the results are encouraging, the evidence remains limited.
Researchers found only three studies that met the review criteria, and all were relatively small. Most of the studies looked back at patient records rather than randomly assigning treatments. This makes it difficult to know whether better outcomes were caused by the treatment itself or by the fact that healthier patients were selected for surgery.
The studies also used different HIPEC medications, surgical techniques, and patient selection criteria.
What’s next?
Several clinical trials are currently underway to better understand whether CRS-HIPEC can safely improve survival and quality of life for patients with pancreatic cancer and peritoneal metastases.
More research is needed before CRS-HIPEC can become a standard treatment recommendation.
Bottom Line
For most patients with pancreatic cancer that has spread to the peritoneum, chemotherapy remains the standard treatment. However, this review suggests that CRS-HIPEC may help a carefully selected group of patients live longer, especially when all visible cancer can be removed during surgery. Larger clinical trials are needed to confirm these findings and identify which patients are most likely to benefit.
