raig daniels
Cytoreductive (CRS) + HIPEC
Surgeon Rankings
A working, personal ranking of the top CRS+HIPEC centers and surgeons worldwide. Evaluated on program volume, CRC-PM outcomes data, surgical expertise, and ACA insurance accepted. Updated as I learn more.
Tier 1 — Elite Programs
These centers represent the highest documented volume, most cited outcomes data, and in several cases are the originating institutions for the surgical protocols used worldwide. Individual surgeon credentials and program-level 1CRC-PM track records are both strong.
| Center | Surgeon(s) | Notes | Status |
|---|---|---|---|
|
Memorial Sloan Kettering New York, NY |
Multiple 646-497-9065 |
CRS + EPIC posture; no longer uses HIPEC for CRC-PM. Important distinction if HIPEC is part of your treatment plan. | ACA Insurance Accepted Sent documents |
| MD Anderson Houston, TX |
Multiple | Highest global volume; strongest CRC-PM outcomes data in the literature. | Submitted web request |
| Wake Forest Baptist Winston-Salem, NC |
Edward Levine | Founding figure in U.S. CRS+HIPEC; longest-running program in the country. | Need to return call |
|
Yale Cancer Hospital New Haven, CT |
Kiran Turaga 203-785-3577 |
Tier 1 surgeon in a Tier 2 institutional program. Guideline leadership, HIPEC + HAI + oligometastatic expertise, active trials. Program CRC-PM volume history is less documented than legacy centers. |
CT Marketplace Insurance $256.75/30 Minutes $412.75/60 Minutes Next Avail April 7 |
| Institut Gustave Roussy Villejuif, France |
Elias, Goéré, Dumont | Protocol originators; primary PRODIGE 7 trial site. | Online form crazy long |
| NKI-AVL Amsterdam, Netherlands |
Multiple | Origin of the landmark RCT establishing HIPEC efficacy; major ongoing CRC-PM program. |
Tier 2 — Strong Programs
High-quality centers with experienced surgeons and active programs.
| Center | Surgeon(s) | Notes |
|---|---|---|
| Moffitt Cancer Center Tampa, FL |
Sean Dineen | Active CRC-PM volume; SSO 2024 presenter on optimal tumor burden criteria. |
| Mayo Clinic Rochester Rochester, MN |
Travis Grotz | Chicago Consensus author; HIPEC + PIPAC both available. |
| Johns Hopkins Baltimore, MD |
Fabian Johnston | Chicago Consensus author; strong and well-documented program. |
| UPMC Hillman Pittsburgh, PA |
M. Haroon Choudry | Historically influential; Chicago Consensus contributor. |
Tier 3 — European Programs
Active European programs with strong multidisciplinary teams. Less CRC-PM-specific public outcomes data compared to Tier 1 European centers, but worth monitoring as published data grows.
| Center | Notes |
|---|---|
| UZ Leuven Leuven, Belgium |
Strong MDT structure; less CRC-PM-specific public outcomes data compared to Tier 1 European centers. |
| Charité Berlin Berlin, Germany |
Active HIPEC program; limited CRC-PM-specific literature prominence. |
Questions to Ask Every Center
Start with the five below. If a center can't answer them — or deflects — that's the answer.
| # | Question | Why It Matters |
|---|---|---|
| 1 | How many CRS procedures do you perform per year? | High-volume centers have better outcomes. Low numbers are a hard stop. |
| 2 | What is your 2CC-0 cytoreduction rate? | Complete cytoreduction (no visible residual disease) is the strongest predictor of survival. CC-0 rate reveals surgical ambition and honest case selection. |
| 3 | What PCI cutoff do you use for colorectal cancer? | PCI ≤20 is the general threshold for benefit; some centers draw the line lower. Their cutoff tells you how they select patients and how they would approach your case. |
| 4 | What are your major complications and 30-day mortality rates? | This is a 10–12 hour operation. A center unwilling to share complication data is not a center you want. |
| 5 | What long-term survival outcomes have your patients achieved? | Median OS and 5-year survival for colorectal CRS patients — not a blended peritoneal malignancy figure. Push for colorectal-specific data. |
If the first five hold up, go deeper.
These next questions separate a center that performs CRS from one that has genuinely mastered it. A center that can answer all of these without deflecting has done the work.
| Question | Why It Matters |
|---|---|
| How many CRS procedures have you personally performed in your career? | Program volume and surgeon volume are not the same number. You want both. |
| What percentage of your cases are colorectal peritoneal metastases specifically? | Appendiceal and ovarian volume inflates program totals. CRC-PM is a distinct surgical and oncological challenge — confirm meaningful colorectal-specific experience. |
| What is your CC-0 cytoreduction rate for colorectal cases specifically? | The blended program rate is less useful than the colorectal-specific figure. |
| How do you determine preoperatively whether CC-0 is achievable? | Look for staging laparoscopy, dedicated peritoneal MRI protocol, and multidisciplinary review as standard workup — not CT alone. |
| How do you evaluate small bowel involvement? | Extensive small bowel disease is a primary reason CC-0 cannot be achieved. How they answer this reveals surgical judgment and how honestly they counsel patients on resectability. |
| What is your 30-day mortality rate? | Should be <3% at high-volume centers. Numbers above that warrant direct follow-up. |
| What is your major complication rate? 3Clavien-Dindo Grade III or higher? |
Grade III+ means re-intervention or ICU-level management. Expect 20–35% at honest high-volume centers — lower numbers may reflect underreporting. |
| What are the average ICU and total hospital stay lengths? | Logistically relevant for planning, and a proxy for how complex their average case is and how efficiently they manage recovery. |
| What is your median survival for colorectal CRS patients? | Benchmark: 30–40 months at high-volume centers for selected CRC-PM patients. Push for colorectal-specific data. |
| What 5-year survival rates have you observed? | Top centers report 20–45% at 5 years in well-selected colorectal patients. Ask about selection criteria — favorable PCI and CC-0 achievement drive those numbers. |
Questions specific to my case
These go beyond the standard evaluation. They come directly from my treatment history and the decisions my case.
| Question | Context |
|---|---|
| Do you use HIPEC, EPIC, or both — and what is your rationale for colorectal peritoneal disease? | MSK has moved to EPIC (early post-operative intraperitoneal chemotherapy) and no longer uses HIPEC for CRC-PM. Most other major centers still use HIPEC. The distinction matters — ask directly and ask why. |
| What intraperitoneal agent do you use for colorectal cases — oxaliplatin, mitomycin C, or something else? | I had oxaliplatin discontinued mid-FOLFOX due to Grade 2 peripheral neuropathy that progressed to severe. Residual sensory deficit persists as of March 2026. Oxaliplatin-based HIPEC warrants direct discussion — prior cumulative neurotoxicity from systemic exposure is a documented risk factor. I need to know whether they default to oxaliplatin and how they weigh prior exposure in that decision. |
| How do you handle patients with prior oxaliplatin-induced peripheral neuropathy when selecting a HIPEC agent? | Mitomycin C and irinotecan-based HIPEC are the main alternatives. I want to know whether they have a protocol for this scenario or whether it is a case-by-case judgment. |
| How do you approach peri-hepatic peritoneal implants near S6/S7 — are those resectable to CC-0 in your hands? | My residual implants are in the peri-hepatic region (S6/S7 capsular) and posterior pelvic pouch. Peri-hepatic disease close to the liver capsule can complicate cytoreduction. This is a direct surgical question about whether my specific disease distribution is manageable at CC-0. |
| Given apparently complete metabolic response on FOLFIRI, how do you stage and time surgery when there is minimal or no visible disease? | PET/CT shows apparently complete metabolic response; MRI shows residual implants significantly reduced. How do they plan and execute CRS when disease burden is minimal radiologically? Do they use staging laparoscopy? What is their protocol for near-complete responders? |
1 CRC-PM (Colorectal Cancer with Peritoneal Metastasis) — Colorectal cancer that has spread to the peritoneum, the membrane lining the abdominal cavity. The designation distinguishes this presentation from other malignancies also treated with CRS+HIPEC, including appendiceal cancer, ovarian cancer, and peritoneal mesothelioma.
2 CC-0 (Completeness of Cytoreduction score 0) — A surgical grading scale used following cytoreductive surgery. CC-0 indicates no visible residual tumor remaining after cytoreduction. CC-1 indicates residual nodules under 2.5mm. CC-2 and CC-3 reflect progressively greater residual disease. CC-0 is the primary surgical outcome target and the strongest predictor of survival benefit from HIPEC.
3 Complication rate (Clavien-Dindo) — A standardized five-grade scale for classifying surgical complications by severity. Grade I requires no intervention beyond standard care. Grade II involves pharmacological treatment. Grade III requires procedural intervention. Grade IV is life-threatening and requires intensive care. Grade V is death. The scale allows consistent comparison of surgical outcomes across institutions and studies.