Neoadjuvant chemotherapy before CRS/HIPEC for metachronous colorectal peritoneal metastases offers no survival benefit and increases complication risks.

• Patients receiving neoadjuvant chemotherapy had a complication rate of 25% versus 12.7% for those undergoing upfront surgery.
• Length of hospital stay increased to 12 days with neoadjuvant treatment compared to 10 days without.

Surgeons should weigh these risks against potential benefits when considering neoadjuvant therapy in these patients.