Turan Eray Seven
Journal of Comprehensive Surgery - 2025;3(4):72-77
Peritoneal metastases (PM) are a common manifestation of advanced gastrointestinal and gynecological cancers and are traditionally associated with poor prognosis. Historically, the peritoneal-plasma barrier and limited drug diffusion have restricted the efficacy of systemic chemotherapy, resulting in short survival times. Since the 1980s, the treatment landscape has been transformed by the locoregional approach introduced by Paul H. Sugarbaker. The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has redefined peritoneal surface malignancies as a potentially local-regional disease entity. Recent phase III trials [PRODIGE-7 (colorectal), OVHIPEC-1 (ovarian), and GASTRIPEC-I (gastric)] have refined the evidence base, showing that CRS remains the strongest prognostic factor, while HIPEC may provide survival benefits in carefully selected cases, depending on primary tumor type and protocol parameters. Despite persistent heterogeneity in HIPEC regimens, growing efforts in biomarker-guided patient selection, AI-assisted imaging, and international data-sharing networks (e.g., PSOGI, RENAPE) are expected to improve standardization and predictability. These developments may optimize both safety and long-term outcomes in the management of peritoneal metastases.
