Early postoperative morbidity and short-term outcomes after cytoreductive surgery and HIPEC for peritoneal surface malignancies: initial single-center experience from Palestine

Vollständiger Abstract

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Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment option for selected patients with peritoneal surface malignancies. However, data from newly introduced programs in resource-constrained settings are limited. We report our initial experience in Palestine, a single center, in evaluating the feasibility, perioperative safety and short-term oncologic outcomes of CRS-HIPEC. Methods We conducted a retrospective descriptive study of all consecutive patients who underwent CRS-HIPEC at Augusta Victoria Hospital, Jerusalem, from the beginning of the program until the end of 2025. Demographic, clinicopathological, operative and postoperative data were obtained from medical records. The results Completeness of cytoreduction, postoperative morbidity, length of hospital stay, recurrence, disease-free survival (DFS), overall survival (OS), quality of life and functional status were the outcomes. Descriptive statistics were used. Results Seventeen patients underwent CRS-HIPEC, with a mean age of 48.0 ± 13.3 years; 64.7% were female. Colorectal (58.8%), ovarian (23.5%), and appendiceal (17.6%) malignancies were the predominant primary tumors. Complete cytoreduction (CC-0) was achieved in all patients, with a mean peritoneal cancer index of 11.6 ± 10.7. The mean operative time was 430 minutes, and the estimated blood loss volume was 340 mL. Most postoperative complications were minor (91.7% Clavien–Dindo grade I–II), whereas one patient (5.9%) developed an anastomotic leak requiring reoperation. There was no 30-day mortality. The mean hospital stay was 12.7 ± 6.6 days. After a mean follow-up of 1.35 ± 0.6 years, the estimated 12-month OS was 91.7%, tumor recurrence occurred in 35.3% of patients, and the mean DFS was 14.8 ± 6.1 months. Most patients remained functionally independent (75.0%), with good or excellent quality of life (76.9%). Conclusion The first CRS-HIPEC program in Palestine showed that this complex treatment can be safely performed in a resource-limited setting with careful patient selection and multidisciplinary collaboration. Acceptable perioperative morbidity and promising short-term results support the feasibility of program implementation, but larger prospective studies with longer follow-up periods are needed to define long-term oncologic efficacy.