Advancements in Prophylactic Intraperitoneal Chemotherapy Following Colorectal Resection

A recent systematic review and meta-analysis found that prophylactic intraperitoneal chemotherapy (PIC) with platinum agents given at the time of curative colorectal resection reduced peritoneal recurrence and improved disease-free survival, with pooled analyses showing no clear signal of excess severe toxicity.

The review reframes perioperative management by comparing PIC with the historical standard of surgery with or without systemic adjuvant chemotherapy and with selective regional approaches such as HIPEC. Across randomized and comparative cohort studies, pooled data consistently suggest that adding a prophylactic regional platinum dose at resection lowers subsequent intraperitoneal relapse risk and improves time-to-event outcomes.

Applicability was principally demonstrated in patients undergoing curative resection for nonmetastatic disease—most commonly stage II–III or other presentations judged at higher risk for peritoneal recurrence.

Pooled efficacy data showed improved disease-free survival (hazard ratio = 0.57) favoring platinum-based PIC in the time-to-event meta-analysis. Overall survival trended toward benefit but did not reach definitive statistical significance, so the survival signal remains provisional. Peritoneal recurrence rates were reduced in pooled estimates but with heterogeneity across studies, indicating variation in effect size by protocol.

Safety data were reassuring: pooled risk ratios for grade 3–4 adverse events and for major postoperative complications were not significantly increased.