EP1023 - Expanding Access to Peritoneal Surface Malignancy Care in the Philippines: The CRS++ HIPEC Project

Purpose/Background: Peritoneal surface malignancies (PSM) are complex conditions requiring specialized treatment approach. In recent years, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been the standard of care for selected patients, offering improved survival. In the Philippines, an archipelago classified as a low- to middle-income country, access to CRS-HIPEC has remained limited, creating a barrier to accessible and standardized care. As a response, the Philippine Society of Colon and Rectal Surgeons (PSCRS) initiated the CRS++ HIPEC Project, a nationwide program aiming to expand knowledge and skills on PSM management through regional educational and surgical activities.

Methods/Interventions: n June 2025, the PSCRS Subcommittee on Peritoneal Surface Malignancies officially launched the CRS++ HIPEC Project. This endeavor involves institutional readiness assessment, multidisciplinary lectures and discussion, and live surgical demonstrations conducted at regional tertiary hospitals across the country. A core feature of the program is the emphasis on a multidisciplinary team (MDT) approach involving surgeons, medical oncologists, critical care specialists, anesthesiologists, radiologists, pathologists, and other specialties involved in the care of a patient with PSM. The acronym CRS then takes on a new meaning-Colorectal Surgery, and ++ represents the other equally important disciplines we align and collaborate with. The program aims to establish standardized approaches in patient selection, operative decision-making, safe execution of the procedure, and sound postoperative care.

Results/Outcomes: As of writing, the preliminary event under this initiative was conducted at the Cotabato Regional and Medical Center (CRMC). This involved initial online discussions with leaders in the medical field in the region to assess the institutions capabilities and needs. Further discussions and lectures were conducted in person, culminating with performing a case of CRS-HIPEC. The patient was a 48/F with appendiceal cancer who had previously undergone appendectomy and evacuation of mucin for a suspected ruptured appendicitis. A core group of surgeons with advanced CRS-HIPEC training performed right hemicolectomy, total omentectomy, selective peritonectomy, HIPEC, and right tube thoracostomy. She was discharged 4 days after surgery. This milestone demonstrated the feasibility of performing CRS-HIPEC in a regional hospital setting with proper mentorship and institutional support. A continuing partnership is foreseen as we improve the hospital's capabilities and processes.

Multiple institutions across the country have already been identified and are scheduled for upcoming CRS++ HIPEC activities. (Fig 1) This is expected to equip and empower them to conduct high-quality and standardized care for patients with PSM.

Conclusion/Discussion: The CRS++ HIPEC Project aims to improve access to necessary procedures for patients with PSM regardless of geographic location. The success of the initial case proves that the project may transform the landscape of PSM management in the country. Collaboration, mentorship, and outcome monitoring should be performed to ensure equitable delivery and sustainability of this program.

Figure 1. Geographic distribution of identified centers in the country where CRS++ HIPEC activities are to be conducted. Provinces scheduled for CRS-HIPEC missions are marked with yellow stars. These planned activities are part of the initiative of the PSCRS to expand access to peritoneal surface malignancy care across the country.
Figure 1. Geographic distribution of identified centers in the country where CRS++ HIPEC activities are to be conducted. Provinces scheduled for CRS-HIPEC missions are marked with yellow stars. These planned activities are part of the initiative of the PSCRS to expand access to peritoneal surface malignancy care across the country.