Clinical efficacy of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in treatment of patients with stage T_3-4 colorectal cancer

Objective To analyze the safety and long-term survival outcomes of cytoreductive surgery (CRS) combined with postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with stage T_3-4 colorectal cancer with or without peritoneal metastasis.

Methods Clinical data from patients with stage T_3-4 colorectal cancer with or without peritoneal metastasis were collected and divided into HIPEC group (CRS+HIPEC+postoperative conventional chemotherapy, n=116) and non-HIPEC group (CRS+postoperative conventional chemotherapy, n=101). To control the confounding effects of peritoneal metastasis, the study was further stratified into non-peritoneal metastasis group (n=170) and peritoneal metastasis group (n=47) based on the presence or absence of peritoneal metastasis. General patient data, postoperative pathological data and levels of gastrointestinal tumor markers were compared among the groups.

Results A statistically significant difference was observed in the incidence of intraperitoneal infection between the HIPEC and non-HIPEC groups (P < 0.05). In both the non-peritoneal metastasis and peritoneal metastasis groups, no statistically significant differences were found in the HIPEC and non-HIPEC patients in terms of gender, age, body mass index, tumor type, pathological classification, lymph node metastasis status and depth of tumor invasion (P>0.05). No statistically significant differences were observed in the preoperative and pre-first, pre-second and pre-third HIPEC tumor marker levels carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and alpha-fetoprotein (AFP) between the HIPEC and non-HIPEC groups (P>0.05). The incidence of perfusion-related adverse reactions and perioperative complications in the HIPEC group showed no significant associations with perfusion days (P>0.05). In the non-peritoneal metastasis group, no statistically significant differences were found in the 1-year, 2-year and 3-year survival rates between the HIPEC and non-HIPEC groups (P>0.05). However, the 1-year survival rate was significantly higher in the HIPEC group compared to the non-HIPEC group (P=0.036).

Conclusion Early postoperative HIPEC treatment in patients with stage T_3-4 colorectal cancer with or without peritoneal metastasis is safe and feasible, with no significant adverse reactions observed. It can effectively improve patient survival rates, particularly offering significant survival benefits for patients with peritoneal metastasis.