{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:17Z","timestamp":1788415937021,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment option for selected patients with peritoneal surface malignancies. However, data from newly introduced programs in resource-constrained settings are limited. We report our initial experience in Palestine, a single center, in evaluating the feasibility, perioperative safety and short-term oncologic outcomes of CRS-HIPEC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective descriptive study of all consecutive patients who underwent CRS-HIPEC at Augusta Victoria Hospital, Jerusalem, from the beginning of the program until the end of 2025. Demographic, clinicopathological, operative and postoperative data were obtained from medical records. The results Completeness of cytoreduction, postoperative morbidity, length of hospital stay, recurrence, disease-free survival (DFS), overall survival (OS), quality of life and functional status were the outcomes. Descriptive statistics were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen patients underwent CRS-HIPEC, with a mean age of 48.0 \u00b1 13.3 years; 64.7% were female. Colorectal (58.8%), ovarian (23.5%), and appendiceal (17.6%) malignancies were the predominant primary tumors. Complete cytoreduction (CC-0) was achieved in all patients, with a mean peritoneal cancer index of 11.6 \u00b1 10.7. The mean operative time was 430 minutes, and the estimated blood loss volume was 340 mL. Most postoperative complications were minor (91.7% Clavien\u2013Dindo grade I\u2013II), whereas one patient (5.9%) developed an anastomotic leak requiring reoperation. There was no 30-day mortality. The mean hospital stay was 12.7 \u00b1 6.6 days. After a mean follow-up of 1.35 \u00b1 0.6 years, the estimated 12-month OS was 91.7%, tumor recurrence occurred in 35.3% of patients, and the mean DFS was 14.8 \u00b1 6.1 months. Most patients remained functionally independent (75.0%), with good or excellent quality of life (76.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The first CRS-HIPEC program in Palestine showed that this complex treatment can be safely performed in a resource-limited setting with careful patient selection and multidisciplinary collaboration. Acceptable perioperative morbidity and promising short-term results support the feasibility of program implementation, but larger prospective studies with longer follow-up periods are needed to define long-term oncologic efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1885478","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:13:37Z","timestamp":1788412417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early postoperative morbidity and short-term outcomes after cytoreductive surgery and HIPEC for peritoneal surface malignancies: initial single-center experience from Palestine"],"prefix":"10.3389","volume":"16","author":[{"given":"Marwan","family":"Abufara","sequence":"first","affiliation":[{"name":"Augusta Victoria Hospital","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qais M.","family":"Alnjoom","sequence":"additional","affiliation":[{"name":"Palestine Polytechnic University","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Siniora","sequence":"additional","affiliation":[{"name":"Augusta Victoria Hospital","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Yacoub","sequence":"additional","affiliation":[{"name":"St John Eye Hospital","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareq","family":"Jarrar","sequence":"additional","affiliation":[{"name":"Al Quds University Faculty of Medicine","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibraheem","family":"AbuAlrub","sequence":"additional","affiliation":[{"name":"Palestine Polytechnic University","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12010103","article-title":"Development of the peritoneal metastasis: A review of back-grounds, mechanisms, treatments and prospects","volume":"12","author":"Ren","year":"2022","journal-title":"J Clin Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/S40265-025-02195-9","article-title":"A clinical pharmacological perspective on intraperitoneal chemotherapy","volume":"85","author":"Rietveld","year":"2025","journal-title":"Drugs"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS16020284","article-title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases from colorectal cancer-an overview of current status and future perspectives","volume":"16","author":"Graf","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS15174314","article-title":"Effects of hyperthermia and hyperthermic intraperitoneal chemoperfusion on the peritoneal and tumor immune contexture","volume":"15","author":"Chia","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS13133114","article-title":"Hyperthermic intraperitoneal chemotherapy: A critical review","volume":"13","author":"Ceelen","year":"2021","journal-title":"Cancers (Basel)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/S12672-024-00968-4","article-title":"Morbidity and mortality of patients with peritoneal Malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","volume":"15","author":"Hotza","year":"2024","journal-title":"Discover Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/S12957-025-03736-Y","article-title":"Evaluating long-term outcomes after cytoreductive surgery for colorectal peritoneal metastasis: Do long survivors really exist","volume":"23","author":"D\u2019Annibale","year":"2025","journal-title":"World J Surg Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3390\/CURRONCOL31070269","article-title":"Long-term outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin","volume":"31","author":"Taqi","year":"2024","journal-title":"Curr Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"5795","DOI":"10.1245\/S10434-025-17518-Z","article-title":"National guidelines for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal Malignancies: A worldwide systematic review and recommendations of strength analysis","volume":"32","author":"Tonello","year":"2025","journal-title":"Ann Surg Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS15010165","article-title":"Colorectal cancer with peritoneal metastases: The impact of the results of PROPHYLOCHIP, COLOPEC, and PRODIGE 7 trials on peritoneal disease management","volume":"15","author":"Sommariva","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/00000421-198212000-00014","article-title":"Toxicity and response criteria of the Eastern Cooperative Oncology Group","volume":"5","author":"Oken","year":"1982","journal-title":"Am J Clin Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/J.EJSO.2013.06.001","article-title":"Peritoneal metastases from colorectal cancer: Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","volume":"39","author":"Riss","year":"2013","journal-title":"Eur J Surg Oncol (EJSO)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3978\/J.ISSN.2078-6891.2015.105","article-title":"Surgical technology and pharmacology of hyperthermic perioperative chemotherapy","volume":"7","author":"Sugarbaker","year":"2016","journal-title":"J Gastrointest Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1245\/S10434-021-10193-W","article-title":"HIPEC methodology and regimens: The need for an expert consensus","volume":"28","author":"Bhatt","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B15","article-title":"NCCN guidelines version 1.2022 Malignant peritoneal mesothelioma continue NCCN guidelines panel disclosures 2021","author":"Gregory","year":""},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.6004\/JNCCN.2024.0052","article-title":"NCCN guidelines\u00ae insights: Ovarian cancer\/fallopian tube cancer\/primary peritoneal cancer, version 3.2024","volume":"22","author":"Liu","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"key":"B17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3978\/J.ISSN.2078-6891.2015.111","article-title":"Chemotherapy for intraperitoneal use: A review of hyperthermic intraperitoneal chemotherapy and early post-operative intraperitoneal chemotherapy","volume":"7","author":"Goodman","year":"2016","journal-title":"J Gastrointest Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.21037\/JGO-2020-05","article-title":"Hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal peritoneal metastases: Lessons learned from PRODIGE 7","volume":"12","author":"Cashin","year":"2021","journal-title":"J Gastrointest Oncol"},{"key":"B19","unstructured":"Tumor Grade - Nci"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0B013E3181B13CA2","article-title":"The Clavien-Dindo classification of surgical complications: Five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2869","DOI":"10.1007\/S11136-024-03740-X","article-title":"The FACT-GP5 as a global tolerability measure: Responsiveness and robustness to missing assessments","volume":"33","author":"Arizmendi","year":"2024","journal-title":"Qual Life Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1245\/S10434-008-9966-2","article-title":"8-year follow-up of randomized trial: Cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer","volume":"15","author":"Verwaal","year":"2008","journal-title":"Ann Surg Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.4251\/wjgo.v2.i2.68","article-title":"Hyperthermic intraperitoneal chemotherapy: Rationale and technique","volume":"2","author":"Gonz\u00e1lez-Moreno","year":"2010","journal-title":"World J Gastrointest Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1200\/JCO.2020.38.4_suppl.390","article-title":"Long-term survival in patients with peritoneal metastasized gastric cancer treated with cytoreductive surgery and HIPEC: A multi-institutional cohort from PSOGI","volume":"38","author":"Brandl","year":"2020","journal-title":"J Clin Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1177\/000313481207800932","article-title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: Initial experience in Oaxaca, Mexico","volume":"78","author":"Barto\u015f","year":"2012","journal-title":"Am SurgeonTM"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3390\/JCM12113774","article-title":"Treatment of peritoneal surface Malignancies by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in Spain: Results of the national registry of the Spanish group of peritoneal oncologic surgery (REGECOP)","volume":"12","author":"Manzanedo","year":"2023","journal-title":"J Clin Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-1039-7","article-title":"Peritoneal carcinomatosis from gastric cancer: A multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy","volume":"17","author":"Glehen","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7800-2-3","article-title":"Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer","volume":"2","author":"Harmon","year":"2005","journal-title":"Int Semin Surg Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1111\/CODI.15411","article-title":"Prognostic factors influencing survival in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated colorectal peritoneal metastases: A systematic review and meta-analysis","volume":"22","author":"van Ramshorst","year":"2020","journal-title":"Colorectal Dis"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.39.7166","article-title":"Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","volume":"30","author":"Chua","year":"2012","journal-title":"J Clin Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3760\/CMA.J.CN441530-20230309-00071","article-title":"Construction and validation of a prognostic nomogram model for colorectal cancer peritoneal metastasis treated with tumor cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy","volume":"26","author":"Songlin","year":"2023","journal-title":"Chin J Gastrointest Surg"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2025.43.16_suppl.e16476","article-title":"Advancing treatment outcomes for peritoneal surface Malignancies in low- and middle-income countries: Insights from the first multicenter study in north Africa","volume":"43","author":"Souadka","year":"2025","journal-title":"J Clin Oncol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA1708618","article-title":"Hyperthermic intraperitoneal chemotherapy in ovarian cancer","volume":"378","author":"van Driel","year":"2018","journal-title":"N Engl J Med"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30239-0","article-title":"Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): A multicentre, open-label, randomised trial","volume":"4","author":"Klaver","year":"2019","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30599-4","article-title":"Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): A multicentre, randomised, open-label, phase 3 trial","volume":"22","author":"Qu\u00e9net","year":"2021","journal-title":"Lancet Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/CNCR.25356","article-title":"Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: A multi-institutional study of 1290 patients","volume":"116","author":"Glehen","year":"2010","journal-title":"Cancer"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9395","article-title":"Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit","volume":"101","author":"Bakker","year":"2014","journal-title":"Br J Surg"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.04.187","article-title":"Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer","volume":"21","author":"Verwaal","year":"2003","journal-title":"J Clin Oncol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS16030631","article-title":"Recurrence and survival following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for synchronous and metachronous peritoneal metastases of colorectal origin","volume":"16","author":"Nielsen","year":"2024","journal-title":"Cancers"},{"key":"B40","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1186\/S12957-025-03923-X","article-title":"Overall survival post secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent colorectal cancer with peritoneal metastases","volume":"23","author":"Hayler","year":"2025","journal-title":"World J Surg Oncol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3393\/AC.2019.04.30","article-title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin C used for colorectal peritoneal carcinomatosis","volume":"36","author":"Roh","year":"2020","journal-title":"Ann Coloproctol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2011.05.004","article-title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: Multi-institutional phase-II trial","volume":"122","author":"Deraco","year":"2011","journal-title":"Gynecol Oncol"},{"key":"B43","unstructured":"OVHIPEC-1 Trial Hyperthermic Intraperitoneal Chemotherapy Plus Interval Cytoreductive Surgery Improves Survival in Advanced Ovarian Cancer - the ASCO Post"},{"key":"B44","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1245\/S10434-021-10045-7","article-title":"Correction to: Impact of socioeconomic status on presentation and outcomes in colorectal peritoneal metastases following cytoreduction and chemoperfusion: Persistent inequalities in outcomes at a high-volume center","volume":"28","author":"Rieser","year":"2021","journal-title":"Ann Surg Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1885478\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:13:42Z","timestamp":1788412422000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1885478\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":44,"alternative-id":["10.3389\/fonc.2026.1885478"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1885478","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1885478"}}