Liver Resection and HIPEC

Synchronous intra-parenchymal hepatic involvement (HI) in patients with peritoneal disease (PD) has traditionally served as a contraindication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, several studies have demonstrated the feasibility and safety of combined liver resection with CRS/HIPEC in well-selected patients with synchronous HI and PD. In patients with low-grade appendiceal (LGA) primaries, HI is generally superficial peritoneal surface disease and functions as a marker for greater volume of disease, rather than contraindication to resection. In patients with colorectal or high-grade appendiceal (HGA) primaries, HI is associated with decreased disease-free survival (DFS) and overall survival (OS), but with the addition of preoperative systemic chemotherapy, a meaningful survival benefit can still be achieved with CRS/HIPEC. In patients with colorectal primaries, major complication rates range from 31% to 47% in patients with HI and 11% to 31% in patients without HI. Thirty-day mortality in patients with HI ranges from 0 to 3%, and 0.6% to 5% in patients without HI. Median OS is 13 to 35.3 months in patients with HI, and from 21 to 45.5 months in patients without HI. In all cases, well-selected patients may benefit from CRS/HIPEC when a complete cytoreduction can be achieved.