Minimally Invasive Versus Open CRS/HIPEC for Peritoneal Surface Malignancies: Postoperative Recovery and Long-Term Outcomes—A Systematic Review and Meta-Analysis
5 affiliations
- 1Pancreatic Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS of Rome, 00168 Rome, Italy
- 2Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore di Roma, 00168 Rome, Italy
- 3General Surgery, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- 4Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- 5MEMOTEF Department, Sapienza University of Rome, 00161 Rome, Italy
Abstract
Background: Minimally invasive surgery (MIS) is increasingly implemented for cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies (PSM). This systematic review and meta-analysis compared minimally invasive CRS/HIPEC (M-CRS/HIPEC) and open CRS/HIPEC (O-CRS/HIPEC) in terms of perioperative, postoperative, and long-term oncological outcomes. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for comparative studies of M-CRS/HIPEC versus O-CRS/HIPEC in adult patients. Risk of bias was assessed using the Newcastle–Ottawa Scale and RoB 2.0. Pooled relative risks (RR) for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes were calculated with 95% confidence intervals (CI). Sensitivity analyses were performed to assess the potential influence of disease burden and primary tumor heterogeneity. Results: Twenty-one studies (1 randomized controlled trial and 20 retrospective cohorts) including 1184 patients (452 M-CRS/HIPEC and 732 O-CRS/HIPEC) were analyzed. Operative time did not differ between groups (SMD = 0.195; p = 0.667). Most cytoreductive procedures were comparable, although small bowel resections were less frequent with M-CRS/HIPEC (RR = 0.537; p = 0.018). The minimally invasive approach achieved higher CC0 rates (RR = 1.053; p = 0.045), with lower blood loss (SMD = −1.838; p < 0.001) and fewer transfusions (RR = 0.588; p = 0.002). Postoperative recovery favored M-CRS/HIPEC, with earlier return of bowel function and resumption of oral intake, shorter hospital stay, fewer readmissions, and earlier chemotherapy resumption (all p < 0.05). Overall and major morbidity were reduced, while postoperative mortality and 1-, 3-, and 5-year disease-free and overall survival did not differ significantly between groups. In the disease burden-restricted sensitivity analysis, differences in small bowel resection, CC0 rate, and 90-day readmission were no longer statistically significant, whereas the main perioperative and recovery benefits persisted. No significant differences in DFS or OS were identified in the additional sensitivity analyses at the evaluable time points. Conclusions: This meta-analysis supports a selective, expertise-driven use of M-CRS/HIPEC, offering perioperative and recovery advantages without significant differences in cytoreductive adequacy or long-term outcomes in appropriately selected patients.
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BibTeX
@article{aulicino2026minimally,
title = {{Minimally Invasive Versus Open CRS/HIPEC for Peritoneal Surface Malignancies: Postoperative Recovery and Long-Term Outcomes—A Systematic Review and Meta-Analysis}},
author = {Matteo Aulicino and Vincenzo Tondolo and Carlo Abatini and Giorgio D’Annibale and Lorenzo Barberis and Maria Saiz and Claudio Fiorillo and Davide De Sio and Giuseppe Quero and Sergio Alfieri and Fabio Pacelli and Francesco Santullo},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203310},
url = {https://www.mdpi.com/2072-6694/18/20/3310},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Minimally Invasive Versus Open CRS/HIPEC for Peritoneal Surface Malignancies: Postoperative Recovery and Long-Term Outcomes—A Systematic Review and Meta-Analysis
AU - Matteo Aulicino
AU - Vincenzo Tondolo
AU - Carlo Abatini
AU - Giorgio D’Annibale
AU - Lorenzo Barberis
AU - Maria Saiz
AU - Claudio Fiorillo
AU - Davide De Sio
AU - Giuseppe Quero
AU - Sergio Alfieri
AU - Fabio Pacelli
AU - Francesco Santullo
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203310
UR - https://www.mdpi.com/2072-6694/18/20/3310
AB - Background: Minimally invasive surgery (MIS) is increasingly implemented for cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies (PSM). This systematic review and meta-analysis compared minimally invasive CRS/HIPEC (M-CRS/HIPEC) and open CRS/HIPEC (O-CRS/HIPEC) in terms of perioperative, postoperative, and long-term oncological outcomes. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for comparative studies of M-CRS/HIPEC versus O-CRS/HIPEC in adult patients. Risk of bias was assessed using the Newcastle–Ottawa Scale and RoB 2.0. Pooled relative risks (RR) for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes were calculated with 95% confidence intervals (CI). Sensitivity analyses were performed to assess the potential influence of disease burden and primary tumor heterogeneity. Results: Twenty-one studies (1 randomized controlled trial and 20 retrospective cohorts) including 1184 patients (452 M-CRS/HIPEC and 732 O-CRS/HIPEC) were analyzed. Operative time did not differ between groups (SMD = 0.195; p = 0.667). Most cytoreductive procedures were comparable, although small bowel resections were less frequent with M-CRS/HIPEC (RR = 0.537; p = 0.018). The minimally invasive approach achieved higher CC0 rates (RR = 1.053; p = 0.045), with lower blood loss (SMD = −1.838; p < 0.001) and fewer transfusions (RR = 0.588; p = 0.002). Postoperative recovery favored M-CRS/HIPEC, with earlier return of bowel function and resumption of oral intake, shorter hospital stay, fewer readmissions, and earlier chemotherapy resumption (all p < 0.05). Overall and major morbidity were reduced, while postoperative mortality and 1-, 3-, and 5-year disease-free and overall survival did not differ significantly between groups. In the disease burden-restricted sensitivity analysis, differences in small bowel resection, CC0 rate, and 90-day readmission were no longer statistically significant, whereas the main perioperative and recovery benefits persisted. No significant differences in DFS or OS were identified in the additional sensitivity analyses at the evaluable time points. Conclusions: This meta-analysis supports a selective, expertise-driven use of M-CRS/HIPEC, offering perioperative and recovery advantages without significant differences in cytoreductive adequacy or long-term outcomes in appropriately selected patients.
SN - 2072-6694
ER -