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CRS paired with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve outcomes in some settings, yet evidence remains contested due to procedure morbidity and mixed trial results, such as PRODIGE 7, PROPHYLOCHIP, and COLOPEC. Gold-standard CRS + HIPEC is established for pseudomyxoma peritonei, while data for gastric and other digestive tumors remain under active evaluation, including emerging PIPAC.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/surgical-options-for-peritoneal-surface-metastases-from-digestive-malignancies-a-comprehensive-review/385537/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/surgical-options-for-peritoneal-surface-metastases-from-digestive-malignancies-a-comprehensive-review/385537.png","ImageObject",300,407,{"name":42,"@type":43},"pixelkiddo","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-28","2026-09-24",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Why do peritoneal surface metastases worsen prognosis in digestive cancers?","Question",{"text":62,"@type":63},"Peritoneal dissemination is consistently linked to poorer outcomes because it reflects widespread tumor spread within the peritoneal cavity, reducing survival compared with other metastatic sites. Systemic therapy responsiveness is also lower for PSM.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What is the role of CRS and HIPEC in selected patients with peritoneal surface metastases?",{"text":67,"@type":63},"Cytoreductive surgery (CRS), combined with systemic chemotherapy, has shown a survival benefit in selected patients. Adding HIPEC may further improve prognosis in certain digestive malignancies, although morbidity and trial results keep the overall benefit controversial.",{"name":69,"@type":60,"acceptedAnswer":70},"What do major colorectal cancer HIPEC trials show?",{"text":71,"@type":63},"The PRODIGE 7 trial reported overall survival improvements with CRS for colorectal cancer but found that oxaliplatin-based HIPEC did not improve long-term outcomes. The PROPHYLOCHIP and COLOPEC trials also failed to show effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases in high-risk patients.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},385537,1790611554,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145},962090883892,"https://ap-avatar.wpscdn.com/avatar/e00115db34f3e0f11b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1790152879550218658","medicina  \nReview  \nSurgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review  \nMihai Adrian Eftimie 1,2, Gheorghe Potlog 1 and Sorin Tiberiu Alexandrescu 1,2, *  \nCitation: Eftimie, M.A.; Potlog, G.; Alexandrescu, S.T. Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review. Medicina 2023, 59, 255. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.3390/medicina59020255](10.3390/medicina59020255)  \nAcademic Editors: Ludovico Abenavoli and Marcello Candelli  \nReceived: 30 December 2022  \nRevised: 25 January 2023  \nAccepted: 25 January 2023  \nPublished: 28 January 2023  \nCopyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \n1 Department of General Surgery, Fundeni Clinical Institute, 022328 Bucharest, Romania  \n2 Department of Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy,  \n050474 Bucharest, Romania  \n* Correspondence: [sorin.alexandrescu@umfcd.ro](sorin.alexandrescu@umfcd.ro)  \nAbstract: The peritoneum is a common site for the dissemination of digestive malignancies, particularly gastric, colorectal, appendix, or pancreatic cancer. Other tumors such as cholangiocarcinomas, digestive neuroendocrine tumors, or gastrointestinal stromal tumors (GIST) may also associate with peritoneal surface metastases (PSM) . Peritoneal dissemination is proven to worsen the prognosis of these patients. Cytoreductive surgery (CRS), along with systemic chemotherapy, have been shown to constitute a survival benefit in selected patients with PSM. Furthermore, the association of CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) seems to significantly improve the prognosis of patients with certain types of digestive malignancies associated with PSM. However, the benefitof CRS with HIPEC is still controversial, especially due to the significant morbidity associated with this procedure. According to the results of the PRODIGE 7 trial, CRS for PSM from colorectal cancer (CRC) achieved overall survival (OS) rates higher than 40 months, but the addition of oxaliplatinbased HIPEC failed to improve the long-term outcomes. Furthermore, the PROPHYLOCHIP and COLOPEC trials failed to demonstrate the effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases development in high-risk patients operated for CRC. In this review, we discuss the limitations of these studies and the reasons why these results are not sufficient to refute this technique, until future well-designed trials evaluate the impact of different HIPEC regimens. In contrast, in pseudomyxoma peritonei, CRS plus HIPEC represents the gold standard therapy, which is able to achieve 10-year OS rates ranging between 70 and 80% . For patients with PSM from gastric carcinoma, CRS plus HIPEC achieved median OS rates higher than 40 months after complete cytoreduction inpatients with a peritoneal cancer index (PCI) 􀀔6 . However, the data have not yet been validated in randomized clinical trials. In this review, we discuss the controversies regarding the most efficient drugs that should be used for HIPEC and the duration of the procedure. We also discuss the current evidence and controversies related to the benefit of CRS (and HIPEC) in patients with PSM from other digestive malignancies. Although it is a palliative treatment, pressurized intraperitoneal aerosolized chemotherapy (PIPAC) significantly increases OS in patients with unresectable PSM from gastric cancer and represents a promising approach for patients with PSM from other digestive cancers.  \nKeywords: peritoneal surface metastases; digestive cancers; colorectal cancer; gastric cancer; appendix ca","cbCaievTzH62Lv90","https://ap.wps.com/l/cbCaievTzH62Lv90","pdf",459266,22,"English","# Abstract\n# Keywords\n# 1. Introduction","[{\"question\":\"Why do peritoneal surface metastases worsen prognosis in digestive cancers?\",\"answer\":\"Peritoneal dissemination is consistently linked to poorer outcomes because it reflects widespread tumor spread within the peritoneal cavity, reducing survival compared with other metastatic sites. Systemic therapy responsiveness is also lower for PSM.\"},{\"question\":\"What is the role of CRS and HIPEC in selected patients with peritoneal surface metastases?\",\"answer\":\"Cytoreductive surgery (CRS), combined with systemic chemotherapy, has shown a survival benefit in selected patients. Adding HIPEC may further improve prognosis in certain digestive malignancies, although morbidity and trial results keep the overall benefit controversial.\"},{\"question\":\"What do major colorectal cancer HIPEC trials show?\",\"answer\":\"The PRODIGE 7 trial reported overall survival improvements with CRS for colorectal cancer but found that oxaliplatin-based HIPEC did not improve long-term outcomes. The PROPHYLOCHIP and COLOPEC trials also failed to show effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases in high-risk patients.\"}]","Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies - A Comprehensive Review | PDF",1790269869,55]