{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T03:53:02Z","timestamp":1776743582510,"version":"3.51.2"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec015\">\n<jats:title>Background<\/jats:title>\n<jats:p>Complete cytoreductive surgery with Hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for patients with peritoneal metastases. In this retrospective observational two-center study, we assessed the impact of patient\u2019s body mass index (BMI) on surgical and oncological outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec016\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Between 2017 and 2021, 144 patients with peritoneal metastases (all etiologies) were included. Morbi-mortality at day-30, overall survival and free-recurrence-survival were compared according to the patients BMI. The patients were divided into 2 groups (BMI\u2009&lt;\u200925, and BMI\u2009\u2265\u200925).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec017\">\n<jats:title>Results<\/jats:title>\n<jats:p>Median overall survival (OS) was 71.3 months [63\u201371.5], with significant differences observed between BMI groups (p\u2009=\u20090.015). Recurrence-free survival (RFS) averaged 26.8 months [20\u201335.3] and did not significantly differ between groups (p\u2009=\u20090.267). After stratification by histology, OS and RFS remained consistent. Cox multivariate analysis adjusted for Peritoneal Carcinomatosis Index (PCI) revealed BMI\u2009&lt;\u200925 (HR\u2009=\u20092.53 [1.10\u20135.80]) and male sex (HR\u2009=\u20092.34 [1.11\u20134.92]) as predictors of poorer OS. 30-Day complication rates did not significantly differ (p\u2009=\u20090.094). The BMI\u2009\u2265\u200925 group experienced higher rates of digestive fistulas (p\u2009=\u20090.05) and 90-day readmissions (p\u2009=\u20090.007), although reintervention rates were comparable (p\u2009=\u20090.723).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec018\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our study suggests a potential \u2018obesity paradox\u2019 in the context of HIPEC procedures. Morbidity at day-30 was similar for BMI\u2009&lt;\u200925, and BMI\u2009\u2265\u200925 patients. Readmissions at day-90 were more frequent in high-BMI group. BMI\u2009&lt;\u200925 is deleteriously associated with mortality. BMI and sex were related to OS.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0325941","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T17:33:07Z","timestamp":1751909587000},"page":"e0325941","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of body mass index on surgical and oncological outcomes after Hyperthermic Intraperitoneal Chemotherapy 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