Impact of Time Between Multidisciplinary Team Meeting Discussion and Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Patients With Colorectal Peritoneal Metastases on Surgical, Quality of Life and Survival Outcomes

Abstract

Introduction: The impact of time delays between multidisciplinary team (MDT) discussion and surgery for colorectal peritoneal metastases remains uncertain. This study evaluated whether the interval between MDT discussion and cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) affected surgical, patient-reported and survival outcomes.

Materials and methods: This single centre retrospective study included patients with colorectal peritoneal metastases who underwent CRS and HIPEC between August 2017 and September 2024. Data on surgical outcomes including postoperative complications and survival were collected. Patient-reported outcomes were assessed using the Short Form 36 Survey (SF-36). Multivariate regression and Cox proportional hazards models assessed associations between MDT-to-surgery interval and outcomes.

Results: One hundred and eighty-five patients who underwent CC0 or CC1 cytoreduction were included. Median MDT-to-surgery time was 28 days (range 19-49). Time from MDT to surgery was not associated with postoperative complications (95% CI: 0.00-0.02, p = 0.13), physical and mental quality of life outcomes (for SF-36 scores at 12 months, 95% CI: -0.09 to 0.05, p = 0.56 and 95% CI: -0.05 to 0.12, p = 0.37 for physical and mental components, respectively) or survival (p = 0.20). Charlson Comorbidity Index (CCI) (95% CI: 0.82-3.90, p = 0.00) and Eastern Cooperative Oncology Group (ECOG) status (95% CI: 1.83-9.38, p = 0.00) were associated with increased postoperative stay. The SF-36 mental component at 6 months correlated with predischarge scores (95% CI: 0.18-0.49, p = 0.00).

Conclusions: Moderate delays in MDT-to-surgery time did not influence outcomes. These findings help to reassure patients who face delays due to patient related or scheduling factors and might facilitate preoperative optimisation. Future research should explore integrated risk models using ECOG and CCI scores to identify patients requiring targeted support.

Keywords: colorectal peritoneal metastases; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; multidisciplinary team; preoperative optimisation; quality of life; surgical outcomes; survival analysis.