Prophylactic hyperthermic intraperitoneal chemotherapy in locally advanced colorectal cancer: A propensity score matched cohort study.

[BACKGROUND] Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial in locally advanced colorectal cancer (CRC). This study aimed to evaluate its survival benefits and safety.

[METHODS] A retrospective cohort of 3008 CRC patients undergoing resection (2014-2019) was analyzed. Propensity score matching (PSM) generated 188 HIPEC and 188 control patients. Outcomes included operative metrics, complications (Clavien-Dindo ≥III), and 3-year overall survival (OS)/disease-free survival (DFS). Multivariable Cox regression identified prognostic factors.

[RESULTS] Post-PSM, HIPEC required longer operative time (215 vs 185 minutes) and hospital stay (9.2 vs 7.5 days), with comparable major complications (12.8% vs 10.6%, P > 0.05). HIPEC showed superior 3-year OS (87.2% vs 80.5%, HR = 0.54, P = 0.029) and DFS (81.7% vs 75.2%, HR = 0.59, P = 0.037). Multivariable analysis confirmed HIPEC (OS: HR = 0.54, 95% CI: 0.31-0.94; DFS: HR = 0.59, 95% CI: 0.37-0.93) and laparoscopic approach as independent survival predictors.

[CONCLUSION] Prophylactic HIPEC (43°C, 60-90 minutes) may improve survival in locally advanced CRC without increasing major complications, supporting its integration into surgical practice. Further validation through multicenter trials is warranted.