Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) significantly enhances peritoneal metastasis-free survival and disease-free survival in patients with locally advanced colorectal cancer, though overall survival rates and complication rates remain unchanged.

• One-year peritoneal metastasis-free survival improved by 48% (HR 0.521), 3-year disease-free survival improved by 67% (HR 0.333), and 5-year disease-free survival improved by 29% (HR 0.714) with prophylactic HIPEC vs. controls.
• No significant differences in overall survival or postoperative complications were observed.

Consider discussing prophylactic HIPEC with patients at high risk for peritoneal metastasis, as it may improve disease-free outcomes.