Survival Benefit of Combining HIPEC with Laparoscopic Pancreaticoduodenectomy in Resectable Pancreatic Head Cancer

Surgical removal of pancreatic cancer carries a substantial risk of locoregional return of disease and peritoneal spread, contributing to a discouraging outlook. This research sought to examine the safety profile and therapeutic benefit of laparoscopic pancreaticoduodenectomy (LPD) when paired with an adapted perioperative hyperthermic intraperitoneal chemotherapy (HIPEC) schedule for malignancies of the pancreatic head amenable to resection. This investigation employed a dual-center, retrospective cohort design, enrolling individuals with resectable pancreatic head cancer who underwent LPD between May 2018 and July 2024. Participants were divided into two groups: one receiving LPD only (n = 54) and one receiving LPD with HIPEC (LPD+HIPEC; n = 55). The HIPEC procedure included hyperthermic saline lavage during the operation, intraperitoneal gemcitabine on day 2 after surgery, and an additional saline lavage on day 4. Overall survival (OS) served as the primary endpoint. Secondary endpoints captured postoperative adverse events and the distribution of disease recurrence. Independent survival determinants were sought using a multivariate Cox proportional hazards framework. The analysis covered 109 subjects. Baseline demographic, clinical, and core oncologic parameters did not differ meaningfully between cohorts. The frequency of severe postoperative adverse events (Clavien-Dindo grade ≥ III) was comparable for the LPD+HIPEC and LPD cohorts (5.5% vs. 5.6%, P = 1.000). Median OS was notably longer in the LPD+HIPEC cohort (27 months; 95% CI: 24.1–29.9) than in the LPD cohort (23 months; 95% CI: 20.5–25.5; P = 0.045). OS rates at the 1-, 2-, and 3-year marks reached 84.9%, 58.2%, and 26.3% for the LPD+HIPEC cohort, whereas the LPD cohort achieved 74.6%, 40.0%, and 15.0%, respectively. The occurrence of locoregional disease recurrence was significantly curtailed in the LPD+HIPEC cohort (14.6% vs. 31.5%, P = 0.035). Multivariate assessment confirmed that receipt of LPD+HIPEC independently predicted better OS (Hazard Ratio: 0.58; 95% CI: 0.35–0.97; P = 0.038). Within the confines of this retrospective review, the integration of LPD with an adapted perioperative HIPEC approach was associated with improved overall survival and reduced locoregional disease recurrence in resectable pancreatic head cancer, without a meaningful increase in severe postoperative complications. These data suggest a potential therapeutic niche for this combined modality, warranting confirmation through a prospective randomized trial.