Abstract / Summary
Abstract Background Laparoscopic cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) has emerged as a minimally invasive alternative for selected patients with colorectal and appendiceal peritoneal metastases (PM). However, evidence comparing laparoscopic and open CRS–HIPEC remains limited. Methods We conducted a retrospective cohort study including all consecutive patients with colorectal or appendiceal PM undergoing CRS–HIPEC at our institution. Propensity score matching (1:2) was performed using age, sex, ASA score, peritoneal cancer index (PCI), and primary tumor location. Perioperative outcomes were compared between laparoscopic and open approaches. Results Nineteen laparoscopic CRS–HIPEC procedures were matched to 38 open CRS–HIPEC controls from a prospectively maintained database (April 2019 to October 2025). Baseline demographics, burden of disease, and surgical complexity were comparable between groups. Median operative time (240 vs. 312 min, p = 0.0045) and intraoperative blood loss (100 vs. 300 mL, p = 0.0188) were lower in the laparoscopic group. Hospital stay was shorter in the laparoscopic cohort (4 vs. 8 days, p = 0.0049). Overall postoperative complications were lower following laparoscopic CRS–HIPEC (26.3% vs. 61.3%, RR 0.43, 95% CI 0.20–0.91, p = 0.0215), while major complication rates (Clavien–Dindo ≥ III) were similar (5.3% vs. 5.9%, p = 1.0). No difference was found in overall survival (94.7% vs. 78.9%, p = 0.247). Conclusions Laparoscopic CRS–HIPEC is safe and feasible in selected patients with low-PCI colorectal and appendiceal peritoneal metastases when performed by surgeons trained in advanced oncologic laparoscopic procedures. This approach is associated with faster postoperative recovery and reduced overall morbidity while maintaining comparable major complication rates and favourable short-term oncologic outcomes. Prospective multicenter studies are needed to confirm long-term oncologic results.