From HIPEC to End-of-Life Care in Patients with Advanced Cancer: Getting to “NO”

Background: Radical debulking with cytoreductive surgery (CRS) and hyperthermic intraperionteal chemotherapy (HIPEC)has been shown to potentially increase disease-free survival in highly-selected patients with certain advanced malignancies, such as pseudomyxoma peritonei, primary peritoneal mesothelioma, ovarian, gastric, and colorectal cancer; and soft tissue sarcoma with peritoneal dissemination. The goal of cytoreductive surgery is to remove all gross disease, at which point HIPEC is administered [1]. However, given the advanced state of disease and the extent of operations required to achieve optimal cyto reduction, the natural history of disease, procedure-related toxicity, anticipated meaningful recovery times, and expected symptomand disease-free survival must be particularly considered.