Perioperative Outcomes and Challenges in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A single-institution case series.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a high-risk, but potentially curative, treatment for peritoneal surface malignancies. This retrospective analysis was conducted between March 2023 and September 2025 at Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman, with the objective of analysing perioperative outcomes and challenges in patients undergoing CRS with HIPEC. Data on demographics, intraoperative variables and postoperative outcomes were collected and statistically analysed. A total of 25 consecutive patients were included. The cohort had significant comorbidities (American Society of Anesthesiologists II/III = 84%). Significant metabolic stress was evidenced by increased lactate (P <0.001) and base deficit (P <0.05). Haemodynamic instability necessitated frequent vasopressor use (noradrenaline = 48%). Postoperatively, 20% developed coagulopathy and 16% renal impairment. Thoracic epidural analgesia was primary in 76% of cases. Prolonged ventilation (>5 days) was needed in 12% and the mortality rate was 8% (n = 2); however, this finding should be interpreted with caution given the limited sample size. Meticulous management of haemodynamics, metabolic stress and tailored multimodal analgesia is crucial. Outcomes align with established literature, underscoring the procedure's complexity and the need for optimised protocols to enhance patient safety.