Selman Sökmen1, Tayfun Bişgin1, Berke Manoğlu1, Canan Altay2, Hülya Ellidokuz3

1Department of General Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
2Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
3Department of Biostatistics, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye


Objective: It was aimed to define the oncologic concept of “extremeness” in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to determine morbidity-mortality results and final oncologic outcomes.

Material and Methods: Prospectively recorded data of 666 patients with peritoneal metastases who had undergone CRS/HIPEC between 2007 and 2020 were analyzed. Patients were divided into two groups as extreme (n= 371) and non-extreme (n= 295). Extreme CRS was defined as resection of ≥5 major organs or creation of ≥2 bowel anastomoses or peritoneal carcinomatosis index (PCI)≥ 15 or re-cytoreductive surgery.

Results: More CC-1 or CC-2 cytoreduction (p< .001), increased mortality and morbidity (p< .001), prolonged operative time (p< .001), increased intraoperative erythrocyte suspension (p< .001), albumin (p< .001), fresh frozen plasma (FFP) (p< .001), and post-operative erythrocyte suspension (p< .001) usage were found in the extreme CRS/HIPEC group. Operative time, CC-1 or CC-2 cytoreduction, presence of ostomy, development of infection, and use of intra-operative albumin and FFP were found to be independent prognostic factors in Cox regression analysis. Three and five-year survival rates were significantly lower in the extreme CRS/HIPEC group (p< .001).

Conclusion: High-volume peritoneal metastatic disease can be completely resected with extreme cytoreduction in carefully selected patients responsive to chemotherapy. Since the significant morbi-mortality related to the treatment of peritoneal metastasis is a real concern, it should be considered in experienced complex cancer centers that provides relatively better oncological outcomes compared to conventional treatments.

Keywords: Cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, peritoneal metastasis

Cite this article as: Sökmen S, Bişgin T, Manoğlu B, Altay C, Ellidokuz H. Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treatment of peritoneal metastasis. Turk J Surg 2023; 39 (1): 43-51.


Ethics Committee Approval

This study was approved by Dokuz Eylül University Non-Invasive Research Ethics Committee (Decision no: 2022/26-17, Date: 17.08.2022).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - SS, TB; Design - SS, TB; Supervision - SS, TB; Fundings - SS, TB; Materials - SS, TB; Data Collection and/ or Processing - SS, TB, BM; Analysis and/or Interpretation - SS, TB, HE; Literature Search - All of authors; Writing Manuscript - All of authors; Critical Reviews - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.