Memorial Sloan Kettering doesn't do HIPEC. Not for colorectal peritoneal metastases.

After PRODIGE 7 was published in 2021, the surgical oncology world had to reckon with an uncomfortable finding: adding oxaliplatin-based HIPEC to CRS showed no survival benefit over CRS alone and was associated with more complications. Many centers continued to offer HIPEC anyway, citing different drug protocols or patient selection criteria.

MSK moved toward Cytoreductive Surgery (CRS) combined with EPIC — Early Postoperative Intraperitoneal Chemotherapy. Instead of heated chemotherapy delivered during surgery, EPIC delivers chemotherapy through a drain or port in the days following — typically days one through five. Normothermic. Repeated infusions over several days rather than a single 60- to 90-minute intraoperative perfusion.

The reasoning: the peritoneal lining is more permeable immediately post-surgery, before adhesions form. That's the window during which intraperitoneal chemotherapy can most effectively reach microscopic residual disease. A sustained multi-day delivery targets that window. One heated perfusion during surgery does not.

MSK handles more peritoneal surface disease than almost any other center in the country. They looked at PRODIGE 7, reviewed their own data, and decided the risk-benefit math on intraoperative HIPEC didn't hold up.

Now, the part specific to my situation.

My neuropathy is already a problem. Oxaliplatin — the agent used in most colorectal HIPEC protocols — is the drug responsible for it. My oncologist pulled it from the last three sessions of my first treatment run. Any center offering oxaliplatin-based HIPEC as its standard protocol puts that directly back on the table. EPIC with 5-FU doesn't.

CRS is a long, technically demanding surgery with significant morbidity. Complication rates track with surgeon and center experience. Volume matters.

New York also matters for a different reason: New York State Marketplace insurance. I spoke with Brandon at MSK today — MSK accepts Marketplace plans, unlike Mercy in Baltimore, which doesn't.

Memorial Sloan Kettering sits at the top of my surgeon rankings list.