Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (HIPEC) with curative intent appears to be an optimal treatment for patients with peritoneal carcinomatosis: effectiveness increases when associated with hyperthermia that improves the OS and DFS for some tumour types, such as ovarian cancer or colon cancer [1]. Hyperthermia promotes the direct drug-cytotoxic effect on the tumour cells at temperature 41–42 °C, enhancing its power to penetrate the peritoneum when administered intra-abdominally, and also ensuring less toxicity [2]. The hyperthermic drug solution acts on the residual tumoral tissue after CRS, however, it must be noted that the amount of microscopic residual disease is the key to determining the OS of these patients [3,4]. The standard technique of HIPEC for the treatment of peritoneal carcinomatosis combining the cytoreductive surgery with intraperitoneal chemotherapy was developed by Paul H Sugarbaker and is known as the Coliseum technique. This technique was initially described as an “open abdomen” session. It was performed by the surgeon, who placed an infusion catheter into the peritoneal cavity through which the heated drug solution was administered. The fluid within the abdominal cavity was then manipulated to improve the optimal exposure to the visceral surface [5]. However, this technique demonstrated some disadvantages, particularly heat dissipation and the potential risk of exposing the operating team to the chemotherapy drugs. As a result, closed abdomen techniques have been proposed as a safer alternative [3,6]. In recent years a new Closed HIPEC technique has been introduced, called the Peritoneal Recirculation System (PRS-1.0 Combat) with CO2 technology [7]. This new equipment supplies the drug solution through input and output tubes in a closed circuit; it provides for the thermal regulation of the perfusate solution and controls the intrabdominal pressure. The recirculating system, together with the CO2 infusion, creates a turbulent flow that increases the mixing of the chemotherapeutic fluid through the visceral walls and peritoneal surfaces, resulting in an increased homogeneous drug penetration within the peritoneal cavity. In a pilot study on patients with peritoneal carcinomatosis of ovarian cancer, the feasibility of Closed HIPEC was considered safe and effective after demonstrating the perioperative outputs and observing hemodynamic data and physiologic response [8,9]. Furthermore, the thermographic images showed a higher homogeneity of the intra-abdominal temperature in the Closed model, emphasizing that the new technique may be better than classical HIPEC methods in terms of optimal control of temperature and chemotherapy distribution [10].

The objective of our study is to present our experience with the PRS compact Closed HIPEC comparing intraoperative, postoperative results, and oncological outcomes with the standard Open HIPEC technique.