Awareness and attitudes toward cytoreductive surgery and hyperthermic intraperitoneal chemotherapy among surgical and medical oncologists

Why this matters for people with abdominal cancers

For many years, cancer that spreads across the lining of the abdomen was seen as almost hopeless, with treatment focused mainly on comfort rather than long-term control. A combined approach called cytoreductive surgery and heated chemotherapy in the abdomen (CRS–HIPEC) has changed that outlook for some patients, offering the chance of longer survival. This study looks not at the patients, but at the cancer specialists in Türkiye who decide whether to offer this demanding treatment—asking how much they know about it, how they feel about its benefits, and what might be holding it back.

What this complex treatment involves

CRS–HIPEC is a two-step attack on cancer that has seeded the thin film of tissue lining the abdomen. First, surgeons aim to remove all visible tumor deposits from this surface in a long, technically difficult operation. Then, while the patient is still in the operating room, heated chemotherapy fluid is circulated through the abdomen to bathe any remaining cancer cells. International expert groups now see this approach as an important option for certain rare abdominal cancers and, in carefully chosen cases, for colorectal and ovarian cancers. Because it is risky, costly, and available only in specialized centers, decisions about offering CRS–HIPEC depend heavily on how well doctors understand the evidence and on how different specialists work together.

How the survey was carried out

The authors conducted a nationwide online survey between July and December 2025 among Turkish doctors formally certified either in surgical oncology or medical oncology. Using a 19-question form, they asked about years in practice, hospital type, exposure to CRS–HIPEC training, availability of the procedure at their institution, and attitudes toward when it should be used and how helpful it is. Answers to opinion questions were scored on a five-point scale from strong disagreement to strong agreement. In total, 98 oncologists responded—50 surgeons and 48 medical oncologists—from university hospitals, training and research centers, state hospitals, and private institutions across multiple regions of Türkiye.

Different views from surgeons and medical specialists

The survey revealed clear differences between the two groups. Surgeons were far more likely to have received specific training in CRS–HIPEC and to work in hospitals where it is performed regularly. They were also much more confident in their own knowledge and in judging which cancers are suitable for the procedure. For several tumor types—including gastric cancer, peritoneal mesothelioma, and appendiceal tumors—surgeons were more inclined than medical oncologists to view CRS–HIPEC as an appropriate option and to rate its benefit as high. When asked whether CRS–HIPEC improves survival in well-chosen patients, nearly nine out of ten surgeons agreed, compared with about three-quarters of medical oncologists. Surgeons most often pointed to economic costs as the main barrier to wider use, while medical oncologists focused on what they saw as limited or uncertain evidence.

Why working together changes opinions

An important insight from the study is the power of multidisciplinary tumor boards—regular meetings where surgeons, medical oncologists, and other specialists jointly review cases. Among medical oncologists, those who took part in such meetings were significantly more likely to believe that CRS–HIPEC improves survival than those who made decisions on their own. Despite their differences, both groups broadly agreed that the treatment is promising for selected patients, that collaboration between disciplines is generally acceptable, and that many centers in Türkiye have at least partial capacity to offer it. Most respondents expected the use of CRS–HIPEC to grow over the next decade, even as key clinical trials continue to shape opinions about the best way to deliver heated chemotherapy.

What this means for future care

The authors conclude that surgeons currently see more benefit in CRS–HIPEC than their medical oncology colleagues, largely because of greater hands-on experience and training. However, the gap narrows when both sides sit together in structured decision-making meetings, suggesting that shared discussion helps align understanding of risks and benefits. Nearly all respondents supported the creation of national guidelines and standardized training programs to reduce uneven access across the country. For patients and families, the message is that CRS–HIPEC can be a valuable option in the right setting, but its use depends not only on the science, but also on how well different cancer specialists communicate, learn from each other, and follow clear, common rules.

Citation: Güler, E., Oğul, A., Sayur, V. et al. Awareness and attitudes toward cytoreductive surgery and hyperthermic intraperitoneal chemotherapy among surgical and medical oncologists. Sci Rep 16, 12930 (2026). https://doi.org/10.1038/s41598-026-43750-y

Keywords: cytoreductive surgery, HIPEC, peritoneal metastases, multidisciplinary oncology, oncologist attitudes