Long-Term Survival Is Possible After CRS/HIPEC for Peritoneal Metastases
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Hamilton T, Lanuke K, Mack LA, Temple WJ. Long-term follow-up in the treatment of peritoneal carcinomatosis. American Journal of Surgery. 2011;201(5):650–654. View the article record on PubMed.
Peritoneal metastases—cancer that has spread to the lining of the abdominal cavity—were once widely considered a terminal condition with few effective treatment options. This study examined whether an aggressive regional treatment approach could offer some patients meaningful, long-term survival.
What Did the Researchers Study?
Researchers followed 101 consecutive patients treated between 2000 and 2008 using a standardized protocol that included:
Cytoreductive surgery (CRS) to remove all visible cancer
Hyperthermic intraperitoneal chemotherapy (HIPEC), which circulates heated chemotherapy throughout the abdominal cavity during surgery
Early postoperative intraperitoneal chemotherapy (EPIC), delivered directly into the abdomen after surgery
The patients had peritoneal metastases from:
Appendix cancer: 58 patients
Colorectal cancer: 31 patients
Other primary cancers: 12 patients
The researchers evaluated disease-free survival—the amount of time patients lived without evidence of cancer—and overall survival.
What Did the Study Find?
The median age of the patients was 49, with ages ranging from 18 to 77. Importantly, surgeons achieved complete cytoreduction, meaning no visible cancer remained after surgery, in 82% of patients.
Results for Appendix Cancer
Among patients with appendix cancer:
Median disease-free survival was 34 months.
48% remained disease-free at three years.
42% remained disease-free at five years.
Overall survival was 76% at three years.
Overall survival was 62% at five years.
Median overall survival had not yet been reached when the study was published, meaning more than half of these patients were still alive.
Results for Colorectal Cancer
Among patients with colorectal cancer:
Median disease-free survival was nine months.
Median overall survival was 27 months.
34% remained disease-free at three years.
26% remained disease-free at five years.
Overall survival was 38% at three years.
Overall survival was 34% at five years.
Why Does This Research Matter?
The study demonstrated that long-term survival was possible for selected patients with peritoneal metastases from appendix or colorectal cancer. At the time, this was especially significant because peritoneal spread was often viewed as uniformly incurable and treated primarily with systemic chemotherapy or symptom-focused care.
The findings also highlight the importance of achieving complete cytoreduction. Most patients in this study had all visible disease removed, reinforcing the principle that the ability to perform a complete or near-complete tumor removal is closely connected to outcomes after CRS/HIPEC.
For patients, this research supports seeking an evaluation at a center experienced in treating peritoneal surface malignancies. Eligibility for CRS/HIPEC depends on several factors, including the cancer’s origin and biology, the extent and location of disease, whether a complete cytoreduction appears possible, and the patient’s overall health.
Important Limitations
This was a relatively small, single-center phase II study without a comparison group receiving another treatment. The patient population also included several different cancer types, and most participants received EPIC in addition to CRS/HIPEC. Therefore, the study cannot determine how much each component of treatment contributed to the results.
Treatment techniques, systemic therapies, patient-selection methods, and supportive care have also evolved since the patients were treated between 2000 and 2008. The findings should be understood as important early evidence rather than a direct prediction of outcomes for patients treated today.
The Bottom Line
This study provided early evidence that peritoneal metastases do not always eliminate the possibility of long-term survival. For carefully selected patients with appendix or colorectal cancer, CRS and HIPEC—particularly when surgeons can remove all visible disease—may offer meaningful disease control and the possibility of living for many years after treatment.
Patients considering CRS/HIPEC should be evaluated by a multidisciplinary team with specific experience in peritoneal surface cancers.
