Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal peritoneal metastases - The Hong Kong experience and literature review

Asian J Surg. 2021 Jan;44(1):221-228. doi: 10.1016/j.asjsur.2020.05.010. Epub 2020 Jun 27.


Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used to treat peritoneal metastases from appendiceal or colorectal origin. We evaluate our institution's experience and survival outcomes with this procedure, and its efficacy in symptom relief.

Methods: This is a single-centre retrospective observational study on patients with peritoneal metastases (PM) from appendiceal neoplasm or colorectal cancer who underwent CRS/HIPEC in Queen Mary Hospital. Our primary endpoints were overall survival (OS) and morbidity and mortality of this procedure; secondary endpoints included disease-free survival (DFS) and symptom-free survival.

Results: Between 2006 and 2018, thirty CRS/HIPEC procedures were performed for 28 patients - 17 (60.7%) had appendiceal PM while 11 (39.9%) had colorectal PM. The median peritoneal cancer index was 20; complete cytoreduction was achieved in 83.3% patients. High-grade morbidity occurred in 13.3% cases. There was no 30-day mortality. Two-year OS were 71.6% and 50% for low-grade appendiceal PM and colorectal PM patients (p = 0.20). Complete cytoreduction improved OS (2-year OS 75.4% vs 20%, p = 0.04). Median DFS was 11.8 months. Median symptom-free duration was 36.8 months; patients with complete cytoreduction were more likely to remain asymptomatic (82.9% at 1 year, vs 60% in incomplete cytoreduction group, p < 0.01). 91.7% low-grade appendiceal PM patients and 58.4% colorectal PM patients remained asymptomatic at post-operative one year (p = 0.31).

Conclusion: CRS/HIPEC is beneficial to appendiceal PM and selected colorectal PM patients - improving survival and offering prolonged symptom relief, with reasonable morbidity and mortality. Complete cytoreduction is key to realising this benefit.

Keywords: Appendiceal peritoneal metastases; Asian-pacific; Colorectal peritoneal neoplasms; Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC); Symptomatic relief.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / administration & dosage*
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / secondary*
  • Appendiceal Neoplasms / therapy*
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / therapy*
  • Cytoreduction Surgical Procedures / methods*
  • Drug Therapy / methods*
  • Female
  • Hong Kong / epidemiology
  • Humans
  • Hyperthermia, Induced / methods*
  • Infusions, Parenteral / methods*
  • Male
  • Middle Aged
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary*
  • Peritoneal Neoplasms / therapy*
  • Survival Rate
  • Time Factors
  • Treatment Outcome


  • Antineoplastic Agents