Impact of cytoreductive surgery with HIPEC in the treatment of pancreatic cancer with peritoneal carcinomatosis: A systematic review.

Pancreatic cancer with peritoneal metastases is associated with a particularly poor prognosis under standard systemic therapy. This systematic review evaluates the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this patient population, focusing on survival, recurrence, and treatment-related morbidity and mortality. Following PRISMA guidelines, a systematic search was conducted across MEDLINE, Web of Science, and SCOPUS. Study quality was assessed using the Methodological Index for Non-randomised Studies (MINORS). Three retrospective studies met the inclusion criteria. Median overall survival ranged from 12 to 26 months. In the only comparative study, median overall survival from diagnosis was 41 months in the CRS-HIPEC group versus 19 months in the control group (systemic chemotherapy). Complete cytoreduction (CC-0) was consistently associated with better outcomes, with a median progression-free survival of 17 months after CC-0 compared with 5 months after CC-1 resection. Major complication rates ranged from 20% to 43%, and perioperative mortality ranged from 0% to 16.7%, although estimates were imprecise owing to small sample sizes. Overall, outcomes appeared highly contingent on careful patient selection based on biological criteria. CRS-HIPEC represents a potential therapeutic strategy for a carefully selected subgroup of pancreatic cancer patients with peritoneal metastasis. However, current evidence is limited to small cohorts. Adequately powered clinical trials are required before definitive clinical recommendations can be established.