Research Spotlight: Cytoreductive Surgery and HIPEC Is NOT a Last Resort: Why Early Referral Matters

Abdominal Cancers Alliance
Aug 25
2 min read

Updated: Aug 26

Leah E. Hendrick, MD, Seth Felder, MD, Iman Imanirad, MD, and Sean P. Dineen, MD, MHPE

JCO Oncology Practice (Oct 2024). Volume 21, Number 4. https://doi.org/10.1200/OP-24-00504

Why This Matters

When patients present with peritoneal metastases from gastrointestinal cancers, there’s often hesitation to consider aggressive surgical options like cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), commonly viewed as a last-ditch effort. This work by Hendrick et al. challenges that misconception, arguing instead for timely referral—shifting the paradigm toward potentially life-saving interventions when delivered earlier.

Key Findings

The authors strongly recommend early surgical referral to a multidisciplinary Peritoneal Disease Team including surgical oncologists experienced in CRS/HIPEC.
The main thrust: CRS/HIPEC should not be reserved as a last-resort, but considered early in the treatment pathway, when patients can still benefit most from its potential curative impact.

Study Strengths & Context

As a perspective piece in JCO Oncology Practice, this article draws upon clinical expertise and emerging consensus rather than presenting original trial data.
Its strength lies in reframing clinical attitudes—highlighting the importance of referral timing and multidisciplinary evaluation for patients with peritoneal disease.

Limitations & Next Steps

This is an expert-opinion narrative rather than a randomized controlled trial or quantitative study.
Additional prospective research is needed to define optimal timing, establish criteria for referral, and measure how early intervention affects survival, quality of life, and healthcare outcomes.

What You Should Know

CRS combined with HIPEC represents a vital therapeutic option—not a last resort.
Early referral to specialized centers with peritoneal disease programs can improve access to care and offer patients the best possible outcomes.
This work reinforces the need for awareness among oncologists, surgeons, and care teams to consider this treatment earlier in the disease trajectory.