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HIPEC finally shows a signal in T4 colon cancer.
But not where you expect.
It reduces peritoneal relapse…
Yet DFS and OS don’t improve.
Here’s HIPECT4 final analysis 👇
🧪 Trial
Resectable cT4N0-2M0 colon cancer
n = 184 randomized
⚔️ Arms
🔹 Surgery + adjuvant chemo
🔹 Surgery + HIPEC (mitomycin C 30 mg/m², 60 min) + adjuvant chemo 
📊 Primary endpoint
36-month locoregional control
🔥 Key result
HIPEC improved peritoneal control:
HR 0.19 (95% CI 0.04-0.86), P=0.031 
❗ But the reality check
No significant difference in:
• DFS
• OS 
🎯 Where benefit was strongest
• Definitive pT4: HR 0.08, P=0.017
• Per-protocol (received chemo): HR 0.18, P=0.028 
🧠 What changed biologically?
Less peritoneal relapse
More systemic pattern of recurrence
No added toxicity 
💡 Takeaway
This is NOT a survival-changing trial.
But it is a pattern-changing trial.
👉 HIPEC may matter in selected high-risk T4 patients
👉 Not ready for universal adoption
🔖 Save this before your next tumor board
📖 Full paper in comment ⬇️
#OncoTwitter #MedTwitter #ColorectalCancer #SurgicalOncology @OncoAlert@myesmo@esmo_open@asco@BJSurgery