Long-term outcomes of laparoscopic cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: comparable with the open approach for limited colorectal peritoneal metastases (KNUCRC-25CR1)

BACKGROUND: Some patients with early-stage colorectal peritoneal metastasis require cytoreductive surgery (CRS) to a limited extent. This study aimed to evaluate the long-term outcomes of laparoscopic versus open surgery for limited peritoneal metastases, including survival outcomes and progression patterns. METHODS: This retrospective study analyzed data from 68 patients who underwent CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) at a single university hospital between January 2014 and December 2021. Postoperative and survival outcomes were compared between the laparoscopic CRS (L-CRS) and open CRS (O-CRS) groups before and after propensity-score (PS) matching. Primary outcomes were overall survival (OS), progression-free survival (PFS), and peritoneal PFS (P-PFS). RESULTS: Of the 68 patients, 42 underwent L-CRS, and 26 underwent O-CRS. After PS matching, preoperative characteristics of the patients were well balanced. Postoperative complications were not different between the two groups. The length of hospital stay was significantly shorter in the L-CRS group than in the O-CRS group. The median OS was 37.3 (95% confidence interval [CI] 15.6-59.0) months in the L-CRS group and 34.1 (95% CI 1.9-66.4) months in the O-CRS group (p = 0.535). PFS and P-PFS were not significantly different between the two groups. Multivariate analysis revealed that extraperitoneal metastasis status was the only significant factor associated with OS and PFS. Progression patterns were not different between the two groups. CONCLUSIONS: L-CRS and HIPEC could achieve comparable oncologic outcomes to open surgery in highly selected patients with limited peritoneal metastases from colorectal cancer.