Colorectal Peritoneal Metastases: Prognostic Stratification, Cytoreductive Surgery, Intraperitoneal Treatment Strategies, and Long-Term Oncological Outcomes

Colorectal peritoneal metastases represent a challenging manifestation of advanced colorectal cancer, characterized by heterogeneous tumor distribution, limited therapeutic accessibility, and variable oncological outcomes. Advances in cytoreductive surgery and intraperitoneal treatment strategies have transformed the management of selected patients; however, controversies persist regarding surgical eligibility, the additional benefit of hyperthermic intraperitoneal chemotherapy (HIPEC), and the optimal integration of systemic therapies. This narrative review critically examines international scientific evidence concerning patient selection, prognostic determinants, cytoreductive surgery, intraperitoneal therapeutic approaches, and oncological outcomes, incorporating the Latin American perspective. Evidence from randomized clinical trials, observational studies, systematic reviews, prognostic investigations, and international consensus recommendations was evaluated through a descriptive and comparative analytical framework. The findings identified completeness of cytoreduction, peritoneal tumor burden, anatomical resectability, and selected clinical and molecular characteristics as important determinants of survival. The PRODIGE 7 trial demonstrated comparable median overall survival following cytoreductive surgery with and without oxaliplatin-based HIPEC (41.7 versus 41.2 months), while severe postoperative adverse events at 60 days were more frequent in the combined-treatment group (26% versus 15%). Prognostic meta-analyses consistently associated incomplete cytoreduction and increasing Peritoneal Cancer Index with unfavorable survival outcomes. Emerging approaches, including pressurized intraperitoneal aerosol chemotherapy, demonstrated preliminary clinical activity, although their long-term survival benefits remain uncertain. Latin American institutional experience highlighted regional advances alongside persistent differences in access to specialized oncological care. Overall, the evidence supports individualized patient selection, complete macroscopic cytoreduction when feasible, and multidisciplinary treatment planning as fundamental principles of management. Further prospective investigations are required to clarify the role of alternative intraperitoneal regimens, integrate molecular prognostic models, and improve oncological outcomes across diverse healthcare settings.