Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in peritoneal sarcomatosis: Therapeutic advancement or clinical controversy? An institutional review
Peritoneal sarcomatosis is a rare and aggressive condition with limited treatment options. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has been explored as a potential therapeutic strategy, although its efficacy remains uncertain. We conducted a retrospective analysis of 24 patients with peritoneal sarcomatosis secondary to uterine and retroperitoneal sarcomas treated at a tertiary oncology center in India between 2014 and 2020. Eligible patients underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy, with follow-up extending for at least 5 years. Outcomes assessed included completeness of cytoreduction (CC-0/1), perioperative morbidity, overall survival, and progression-free survival. The cohort comprised patients with 16 uterine sarcoma and 8 patients with retroperitoneal sarcoma. Complete cytoreduction (CC-0/1) was achieved in 92% of cases. The median overall survival was 35 months (uterine: 32 months; retroperitoneal: 38 months), with 1-, 3-, and 5-year survival rates of 75%, 50%, and 30%, respectively. The median progression-free survival was 14 months, with a recurrence rate of 67%. Postoperative complications occurred in 17%, with no 30-day mortality. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy offers a potential survival benefit for select patients with peritoneal sarcomatosis, particularly those with complete cytoreduction. Although recurrence rates remain high, this approach may improve outcomes compared with systemic therapy alone. Further prospective studies are needed to refine patient selection and optimize treatment strategies.