Comparative clinical trial of open versus closed technique for intraoperative hyperthermic intraperitoneal chemotherapy in peritoneal metastases from colorectal cancer

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has emerged as a transformative approach to treating peritoneal surface malignancies. Two main HIPEC delivery techniques exist: the open technique (OT) and the closed technique (CT), including variations such as CO₂ recirculation systems. Comparative studies are limited and mostly retrospective. In this exploratory clinical trial, consecutive patients with colorectal peritoneal metastases between March and September 2015 were randomized to OT or CT with CO₂ infusion (CT-CO₂). Intraoperative physiological parameters, postoperative outcomes, and survival were compared. Twenty patients were randomized (9 OT and 10 CT-CO₂ included in the final analysis). Both techniques maintained safe hemodynamic, metabolic, and temperature profiles without statistically significant differences. Intraabdominal pressure increased moderately in CT-CO₂ but remained within safe limits. Minor complications were more frequent in the CT-CO₂ group, though major complications were similar. Both OT and CT-CO₂ are safe options for HIPEC administration. The study’s exploratory nature and limited sample size represent important limitations. Further trials including a conventional closed HIPEC arm are warranted.