Textbook oncologic outcomes after cytoreductive surgery and HIPEC for colorectal peritoneal metastases: a single-centre cohort analysis

Abstract Objectives Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for selected patients with colorectal peritoneal metastases (CPM). The recently proposed concept of textbook oncologic outcomes (TOO) offers a composite benchmark for surgical quality, but its applicability and prognostic relevance in CPM remain largely unexplored. Methods We conducted a retrospective single-centre analysis of all patients undergoing CRS and HIPEC for CPM between 2007 and 2025. Primary endpoint was overall survival (OS); secondary analyses assessed individual TOO components and associated factors. Results Eighty-four patients met inclusion criteria (age 54.1 ± 12.1 years, PCI 5.8 ± 4.5). CC0 resection was achieved in 88.1 %, severe postoperative complications occurred in 34.5 %, and reoperation was required in 20.2 % of patients. Ninety-day mortality was 1.2 %. Complete TOO was achieved in 14.3 % of patients as only 31/84 were recommended adjuvant chemotherapy. Median OS was 39.2 months. Absence of reoperation (p=0.02), and negative lymph node status (p=0.04) were significantly associated with improved OS. Conclusions TOO was achieved in <50 % of patients, mainly due to the absence of adjuvant chemotherapy. Absence of reoperation was associated with survival, suggesting its validity as quality indicator. Refinement of TOO definitions, incorporating patient-centred recovery measures, may improve their applicability.