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Assoc. Prof. Cengiz Dibekoğlu, MD

General Surgeon · Laparoscopic · Robotic · Oncologic Surgery

CRS & HIPEC

Peritoneal Metastasis, CRS & HIPEC

Two components — not a miracle package for everyone

First question: is complete cytoreduction possible? HIPEC is not automatic.

Cytoreductive surgery (CRS) and HIPEC are related but separate. CRS aims to remove visible peritoneal disease; HIPEC adds heated intraperitoneal chemotherapy in selected protocols afterward. HIPEC is not standard for all peritoneal disease and is not an automatic add-on to every CRS. In colorectal peritoneal metastases, PRODIGE-7 showed no overall-survival benefit for oxaliplatin HIPEC — this must be discussed honestly. PCI score, primary tumor type, fitness, and likelihood of complete cytoreduction decide candidacy. If you are not a candidate, saying so clearly is better than the wrong large operation.

Mixed deposits and an omental cake · educational illustration

Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

© Cengiz Dibekoğlu — illustrative; not for unauthorized use

Figure summary

  • Hero figure: thick liver lobe on the left of the figure, with mixed flat and raised deposits and an omental cake.
  • Related figures explain cytoreduction, intraperitoneal chemotherapy, and patient selection themes.

Educational figures

Tap a figure to enlarge. These English illustrations mirror the Turkish hub gallery for this condition.

  • PCI & CC score

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

  • Candidacy

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

  • Process

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

  • Limits

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

  • CRS ≠ HIPEC

    Clear the disease first; heated chemo is an add-on in selected cases.

  • PRODIGE-7

    Oxaliplatin HIPEC is not a general overall-survival miracle in colorectal PM.

  • Selection

    PCI, primary tumor type, and fitness matter.

  • Honesty

    If you are not a candidate, we say so clearly.

What to know

  • What CRS means

    Surgical removal of visible peritoneal disease aiming for completeness (CC-0/CC-1). Incomplete cytoreduction rarely justifies maximal morbidity.

  • What HIPEC means

    Key note inside
    Note: HIPEC is not standard for everyone.

    Heated intraperitoneal chemotherapy after CRS in selected protocols — not mandatory for every CRS.

  • Evidence boundaries

    Key note inside

    In colorectal peritoneal metastases, oxaliplatin HIPEC did not improve overall survival in PRODIGE-7. Other histologies and protocols have different evidence weight.

  • Gastric + extensive peritoneum

    Key note inside

    Gastric cancer with extensive peritoneal disease rarely fits a curative HIPEC narrative. Goals must stay realistic.

  • Who is reviewed

    Patients with limited PCI, favorable biology, and fitness for major surgery are discussed at the tumor board with complete imaging and prior operative records.

What happens next

CRS vs HIPEC, PCI and CC scoring in plain language

Oncologic surgery4 chapters

Evidence

Scientific sources

Show sources · 4

Guidelines and key evidence for peritoneal metastases / HIPEC decisions. HIPEC is not automatic with every CRS.

  1. 1. ESMO metastatic colorectal cancer guideline (peritoneal disease context)ESMO · 2023 · DOI: 10.1016/j.annonc.2022.10.003Open source →
  2. 2. PRODIGE 7 — Cytoreductive surgery with or without oxaliplatin HIPEC in colorectal peritoneal metastases (RCT)Lancet Oncology (trial evidence; not a society guideline) · 2021 · DOI: 10.1016/S1470-2045(20)30599-4Open source →
  3. 3. PSOGI — Peritoneal Surface Oncology Group International (education / consensus)PSOGI · Resource portalOpen source →
  4. 4. NCCN Clinical Practice Guidelines in Oncology: Colon CancerNational Comprehensive Cancer Network (NCCN) · Current versionOpen source →

Last reviewed: 21 August 2026. Links go to publisher pages.

Appointment / info

Complete imaging and prior operative/pathology records are required for a serious CRS/HIPEC review.

+90 542 725 50 70WhatsAppTumor boardFull Turkish hub →

This page is for education. It is not medical advice and does not replace a visit with your physician.

Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · English patient-education hub.

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