TABLE 5.

CRS Plus HIPEC and Chemotherapy (FU plus folinic acid) Versus Chemotherapy for mCRC Patients With Colorectal Peritoneal Metastases and No Distant Metastases⁵⁸

Outcome, Time Frame	Study Results	Absolute Effect Estimates		Quality of Evidence	Plain Language Summary
		FU Chemotherapy	CRS + HIPEC + FU Chemotherapy
OS, 24 months	HR, 0.55 (95% CI, 0.32 to 0.95) (105 participants in one study)	902 deaths per 1,000	721 deaths per 1,000	Moderatea	Risk of death was lower for patients with mCRC and colorectal peritoneal metastases treated with CRS plus HIPEC, compared with chemotherapy alone
		Difference: 181 fewer per 1,000 (95% CI, 378 fewer to 12 fewer)
Treatment-related mortality	The mortality rate was 8% in the CRS plus HIPEC arm, attributable at least partially to the extent of surgery, which was related to the extent of peritoneal metastases. Extent of disease was reportedly difficult to predict preoperatively			High	Treatment-related mortality risk is increased with CRS plus HIPEC, compared with chemotherapy alone
Grade ≥ 3 AEs and surgical complications	Rate of grade 3–5 adverse events was 65%, and rate of surgical complications (ie, postoperative events needing reintervention) was 35% among patients undergoing CRS plus HIPEC			High	Risk of adverse events and surgical complications are increased with CRS plus HIPEC

Abbreviations: AE, adverse event; CRS, cytoreductive surgery; FU, fluorouracil; HIPEC, hyperthermic intraperitoneal chemotherapy; HR, hazard ratio; mCRC, metastatic colorectal cancer; OS, overall survival.

^aDowngrade: the effect on OS may have been due to the impact of CRS alone.