Prophylactic hyperthermic intraperitoneal chemotherapy in patients with high-risk colorectal cancer with abdominal metastasis: a systematic review and meta-analysis.

BACKGROUND

Peritoneal metastasis is a form of colorectal cancer metastasis associated a very poor prognosis. For patients at high risk of peritoneal metastasis, prophylactic hyperthermic intraperitoneal chemotherapy aims to eliminate subclinical lesions within the abdominal cavity to prevent recurrence; however, its clinical efficacy remains a subject of debate. METHOD: According to the PRISMA guidelines, studies comparing radical surgery combined with prophylactic HIPEC versus surgery alone in patients with high-risk colorectal cancer and peritoneal metastasis were systematically retrieved from PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials and cohorts were included.Hazard ratios and their 95% confidence intervals were pooled using random-effects or fixed-effects models. RESULT: A total of 8 studies, involving 2,437 patients were included.The meta-analysis results indicated that combined prophylactic HIPEC significantly improved disease-free survival compared with surgery alone (HR = 0.80, 95%CI: 0.66–0.98, P = 0.028). However, there was no statistically significant difference in overall survival between the two groups (HR = 0.90, 95%CI: 0.64–1.27, P = 0.549). Sensitivity analysis confirmed the robustness of the results, and the heterogeneity among the included studies was low.

CONCLUSION

For patients with colorectal cancer at high risk of abdominal metastasis, adding prophylactic HIPEC to radical surgery significantly improves disease-free survival, but no significant benefit in overall survival was observed.