Palliative cytoreductive surgery with hyperthermic chemotherapy for peritoneal carcinomatosis

Background: Peritoneal carcinomatosis (PC) is a debilitating condition associated with high symptom burden and poor prognosis. While systemic chemotherapy has historically been the standard for palliation, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a potential strategy for symptom palliation and extended survival. This review evaluates the palliative impact of CRS-HIPEC in the context of its survival benefit to determine whether prolonging survival aligns with improved quality of life and symptom control. Methods: We conducted a scoping review of PubMed full-text English-language articles from 1989 to 2025, focusing on systematic reviews, meta-analyses, and randomized controlled trials evaluating palliative systemic chemotherapy, CRS, or CRS-HIPEC in patients with PC. Extracted data included indications, symptom outcomes, perioperative complications, survival, and quality of life measures. Results: Fifty-four studies were included. PC origin was most commonly colorectal (n = 27), gastric (n = 19), ovarian (n = 2), and others (n = 6). CRS-HIPEC resolved malignant ascites in up to 100% of patients. Symptom improvement was observed in 26.5 to 100% of cases, with durable control reported in up to 90%. Median survival after CRS-HIPEC ranged from 6.6 to 50 months compared to systemic chemotherapy alone (5.2 to 12.6 months) and CRS alone (2 to 8.5 months) across different primaries. CRS-HIPEC’s 5-year survival reached up to 31% in selected cohorts. However, it is noteworthy that morbidity ranged from 15.1 to 56% and postoperative mortality ranged from 0 to 12%. Conclusions: Our findings suggest that CRS-HIPEC not only extends survival but does so without compromising palliation, thereby emphasizing that its benefits in longevity do not come at the cost of patient comfort. Its integration into palliative care strategies warrants further study through high-quality trials with standardized symptom and quality of life measures.