Peritoneal surface malignancies — cancer that has spread across the lining of the abdominal cavity, whether originating from the appendix, colon, ovary, stomach, or the peritoneum itself — present a distinct treatment challenge. Because disease is often spread diffusely across multiple surfaces rather than confined to a single site, treatment requires an approach that addresses both what can be seen and what can’t.

CRS with HIPEC combines two stages in one operation. Cytoreductive surgery first removes all visible tumour from the abdominal cavity, which can involve extensive dissection and, where needed, resection of affected organs or peritoneal surfaces to achieve complete or near-complete clearance. Immediately following this, heated chemotherapy is circulated directly through the abdominal cavity for a defined period, targeting microscopic residual disease left behind after surgery — using heat and direct contact to enhance the chemotherapy’s effect in a way that intravenous treatment alone cannot achieve.

Patient selection is critical to this approach. Careful pre-operative imaging and assessment of disease extent — often summarised using the Peritoneal Cancer Index — determine whether complete cytoreduction is achievable, since the extent of residual disease after surgery is one of the strongest predictors of outcome. Every case is reviewed by a multidisciplinary tumour board — surgical oncology, medical oncology, and radiology working together to confirm suitability and plan the procedure carefully.