The combination of complete cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy provides
the chance for a long-term survival for selected patients with a variety of peritoneal neoplasms, either primary
or secondary. The aim of CRS is to eliminate all macroscopic diseases through a series of visceral resections. Hyperthermic
intraperitoneal chemotherapy (HIPEC) delivered in the operating room once the cytoreductive surgical
procedure is finalized, constitutes the most common form of administration of perioperative intraperitoneal chemotherapy.
HIPEC combines the pharmacokinetic advantage inherent to the intracavitary delivery of certain cytotoxic
drugs, which results in regional dose intensification, with the direct cytotoxic effect of hyperthermia. Hyperthermia
exhibits a selective cell-killing effect in malignant cells by itself, potentiates the cytotoxic effect of certain chemotherapy
agents and enhances the tissue penetration of the administered drug. The chemotherapeutic agents employed
in HIPEC need to have a cell cycle nonspecific mechanism of an action and should ideally show a heat-synergistic
cytotoxic effect. Different HIPEC drug regimens and dosages are currently in use. Future trials to ascertain
the ideal HIPEC regimen in different diseases and to evaluate the efficacy of new drugs or drug combinations in
this context are warranted.