Management of peritoneal metastases from colorectal cancer and small bowel adenocarcinoma in patients with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer, which may ultimately result in peritoneal metastases (PM). PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD. This minireview compiled existing evidence on management approaches to PM in patients with IBD, including surgical procedures, systemic treatment, and novel therapies. A literature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer. Literature specific to PM in IBD is sparse, comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with and without IBD. These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD. However, median overall survival (approximately 19.6-24.0 months) and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD. Although CRS/HIPEC can be performed safely in selected patients with IBD and PM, long-term oncologic outcomes appear inferior compared to populations without IBD, likely reflecting later-stage presentation, distinct tumor biology, and IBD-related factors.