Safety of Secondary CRS/HIPEC in Peritoneal Surface Malignancies: Insights from a National Cohort Study
Menée à l'aide de données d'un registre allemand portant sur 5 247 patients présentant des tumeurs malignes de la surface péritonéale, cette étude analyse les taux de réintervention et de mortalité à 30 jours lors d'une chirurgie cytoréductive, qu'elle soit primaire ou secondaire, en combinaison avec une chimiothérapie intrapéritonéale hyperthermique
Background: For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied.
Methods: A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts.
Results: A comprehensive analysis of 5,011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15% vs. 12%, p = 0.192) or 30-day mortality (2% vs. 1%, p = 0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12% in both groups (p = 1.000) and similar 30-day mortality (2% vs. 1%, p = 0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27%), pseudomyxoma peritonei (21%), or colorectal cancer (20%), mesothelioma (12%) and ovarian cancer (10%).
Conclusions: Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.
European Journal of Surgical Oncology , article en libre accès, 2026