Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Awareness and Attitudes Among Surgical and Medical Oncologists

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However, awareness, training exposure, and attitudes toward CRS–HIPEC vary among oncologic disciplines. This nationwide study aimed to assess and compare the knowledge, awareness, and perceptions of surgical and medical oncologists in Türkiye regarding CRS–HIPEC indications, benefits, and implementation. Methods: A cross-sectional, web-based survey was conducted between July and December 2025 among certified surgical and medical oncologists. A 19-item questionnaire evaluated demographics, CRS–HIPEC training, institutional practices, and attitudes using a five-point Likert scale. Results: Ninety-eight oncologists (50 surgical, 48 medical) participated nationwide. HIPEC-related training (p < 0.001), self-rated knowledge (p < 0.001), and awareness of indications (p = 0.035) were significantly higher among surgical oncologists. Agreement with “CRS–HIPEC improves survival in appropriate patients” was stronger in the surgical group (p = 0.006). Among medical oncologists, those participating in multidisciplinary tumor boards were more likely to agree with the survival benefit (p = 0.032). Overall, 92% of participants supported the need for a national CRS–HIPEC guideline or standardized protocol. Conclusions: Surgical oncologists report greater training exposure and stronger belief in the benefit of CRS–HIPEC; however, multidisciplinary collaboration enhances understanding and acceptance among medical oncologists. Unified national guidelines and structured training programs may help align perspectives and optimize multidisciplinary practice. Biological sciences/Cancer Health sciences/Oncology Cytoreductive surgery (CRS) Hyperthermic intraperitoneal chemotherapy (HIPEC) Medical oncology Multidisciplinary decision-making Surgical oncology Figures Figure 1 Figure 2 Introduction Peritoneal surface malignancies (PSMs) represent a heterogeneous group of cancers involving the peritoneum, most commonly originating from gastrointestinal or gynecologic primaries. Historically, peritoneal metastasis was considered a terminal manifestation managed mainly with systemic chemotherapy and palliative surgery. Over the past two decades, however, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved outcomes by offering selected patients the potential for durable survival [ 1 , 2 ]. Recent consensus efforts, including the Peritoneal Surface Oncology Group International (PSOGI) and the French Rare Peritoneal Tumors Network (RENAPE 2022), together with major guidelines from the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN), emphasize that CRS ± HIPEC should be performed only in experienced, high-volume centers following multidisciplinary tumor-board review [ 3 – 6 ]. Strongest evidence supports CRS-HIPEC in appendiceal tumors/pseudomyxoma peritonei and peritoneal mesothelioma, whereas its role in colorectal and ovarian metastases is limited to carefully selected patients [ 3 – 6 ]. For gastric cancer, CRS-HIPEC remains investigational and is generally restricted to clinical trials [ 6 ]. Despite these recommendations, real-world practice often diverges, reflecting institutional experience, patient selection differences, and variations in interdisciplinary coordination [ 1 , 4 ]. Prior survey-based studies have demonstrated substantial variability in clinician knowledge and attitudes toward CRS-HIPEC, particularly between surgical and medical oncologists, highlighting gaps in awareness and evidence-based adoption [ 7 – 9 ]. However, most previous work has been surgeon-focused or limited to specific tumor types, leaving medical oncologists relatively underrepresented and broader HIPEC indications insufficiently evaluated [ 7 – 9 ]. The present study aims to address this gap by evaluating the knowledge, awareness, and attitudes of both surgical and medical oncologists toward CRS-HIPEC in Türkiye. With nearly equal participation from both groups, this nationwide analysis provides one of the few balanced multidisciplinary assessments and may support improved interdisciplinary education, communication, and guideline adherence in the management of peritoneal surface malignancy [ 7 – 9 ]. Methods Study Design and Participants This cross-sectional, questionnaire-based study was conducted between July and December 2025 to assess the awareness and attitudes of Turkish oncologists toward cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The target population included physicians officially certified as Surgical Oncologists or Medical Oncologists by the Turkish Ministry of Health and the Council of Higher Education (YÖK). To ensure homogeneity, general or gastroenterologic surgeons without formal surgical oncology certification were excluded. The survey was distributed electronically through the Turkish Society of Surgical Oncology (TSSD) and the Turkish Society of Medical Oncology (TTOD) via official mailing lists and society WhatsApp groups. Follow-up phone or email invitations helped maintain balanced participation. In total, 98 certified oncologists (50 surgical, 48 medical) from tertiary university hospitals, training and research institutions, and comprehensive cancer centers across Türkiye completed the survey. Participation was voluntary and anonymous; incomplete or duplicate responses were excluded. The final cohort proportionally represented Türkiye’s subspecialized oncologic community. Questionnaire A structured 19-item questionnaire was developed based on prior studies [ 7 – 9 ] and aligned with PSOGI and ESMO/NCCN recommendations. The items covered four domains: 1. Demographics and professional background (experience, institution type, specialty, involvement in CRS-HIPEC cases), 2. Knowledge and attitudes toward CRS-HIPEC indications and survival benefit, 3. Institutional practice patterns (multidisciplinary board vs. individual decisions), and 4. Awareness of guidelines and participation in HIPEC-related education. All questions were multiple- or single-choice, with attitude statements rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). The draft survey was reviewed by experts from both specialties and pilot-tested among ten oncologists for clarity and technical performance before nationwide dissemination. Statistical Analysis Data were analyzed using IBM SPSS Statistics, version 29.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics summarized participant characteristics. Group comparisons between surgical and medical oncologists were conducted using the Chi-square or Fisher’s exact test as appropriate. Subgroup analysis evaluated the association between decision-making models (multidisciplinary board vs. individual physician) and perceptions of CRS-HIPEC survival benefit. A p-value < 0.05 was considered statistically significant. Ethical Considerations The study was approved by the Mersin University Clinical Research Ethics Committee (No. 2025/1245) and conducted in accordance with the Declaration of Helsinki. All participants provided electronic informed consent, and no identifying data were collected. Results Participant Characteristics A total of 98 oncologists completed the survey (50 surgical oncologists, 48 medical oncologists) from tertiary university hospitals, training and research institutions, and comprehensive cancer centers across Türkiye. All participants held official subspecialty certification in either surgical or medical oncology. General or gastroenterologic surgeons without a formal surgical oncology title were intentionally excluded to ensure a homogeneous expert cohort. The sample reflects the proportional national distribution of certified subspecialists and provides a balanced expert representation at the national level (Table 1 ). Table 1 Baseline characteristics of the participants (n = 98) Variable Category n (%) Specialty Surgical oncology 50 (51.0) Medical oncology 48 (49.0) Years in oncology practice 0–5 years 28 (28.6) 6–10 years 29 (29.6) 11–15 years 26 (26.5) ≥ 16 years 15 (15.3) Institution type University hospital 42 (42.9) Training and research hospital 18 (18.4) State/City hospital 23 (23.5) Private hospital 13 (13.3) HIPEC performed in current institution Yes, limited volume 53 (54.1) Yes, routinely performed 36 (36.7) No 9 (9.2) Received CRS–HIPEC training Yes, formal course/training 31 (31.6) Yes, observership/rotation 21 (21.4) No 46 (46.9) Values are n (%). HIPEC = Hyperthermic Intraperitoneal Chemotherapy; CRS = Cytoreductive Surgery Comparison Between Surgical and Medical Oncologists Participation in HIPEC-related education or training was significantly higher among surgical oncologists (p < 0.001). Likewise, self-rated knowledge level on CRS + HIPEC (p < 0.001) and awareness of its indications (p = 0.035) were also greater among surgical oncologists. The availability or routine performance of CRS + HIPEC at participants’ institutions was more frequently reported by surgical oncologists (p = 0.027), and they were more familiar with the number of CRS + HIPEC cases performed within the last year (p = 0.002). Agreement with the statement “CRS + HIPEC improves survival in appropriate patients” was also stronger among surgical oncologists compared with medical oncologists (p = 0.006). Among medical oncologists, subgroup analysis revealed that those indicating CRS + HIPEC decisions were made through a multidisciplinary tumor board were more likely to agree that the procedure improves survival in eligible patients (p = 0.032), suggesting that participation in multidisciplinary decision-making may enhance confidence in CRS + HIPEC outcomes. The main barrier to CRS + HIPEC implementation also differed significantly between the groups; surgical oncologists most frequently identified economic costs, whereas medical oncologists more often cited the lack of evidence-based data (p < 0.001) (Table 2 ) Table 2 Comparison of responses between surgical and medical oncologists (only significant items) Survey Item Responses Surgical Oncology (n, %) Medical Oncology (n, %) p-value Participation in HIPEC-related education/training Observation/internship Formal course/training No 15 (30.0%) 24 (48.0%) 11 (22.0%) 6 (12.5%) 7 (14.6%) 35 (72.9%) < 0.001 Self-rated knowledge level on CRS + HIPEC Good Expert Moderate Insufficient 23 (46.0%) 14 (28.0%) 13 (26.0%) 0 (0.0%) 9 (18.8%) 2 (4.2%) 29 (60.4%) 8 (16.7%) < 0.001 Awareness of indications for CRS + HIPEC Yes Partially 40 (80.0%) 10 (20.0%) 28 (58.3%) 20 (41.7%) 0.035 CRS + HIPEC performed in their institution Regularly Limited number Not performed 22 (44.0%) 27 (54.0%) 1 (2.0%) 14 (29.2%) 26 (54.2%) 8 (16.7%) 0.027 Knowledge of number of CRS + HIPEC cases in past 12 months 11 cases 5–10 1–5 0 / Unknown 21 (42.0%) 17 (34.0%) 10 (20.0%) 2 (4.0%) 9 (18.8%) 10 (20.8%) 14 (29.2%) 15 (31.2%) 0.002 Belief that CRS + HIPEC improves survival in eligible patients Strongly agree Agree Neutral Disagree 23 (46.0%) 21 (42.0%) 5 (10.0%) 1 (2.0%) 8 (16.7%) 27 (56.2%) 13 (27.1%) 0 (0.0%) 0.006 Main barrier to CRS + HIPEC implementation Economic costs Lack of evidence-based data Lack of infrastructure Lack of experienced team 26 (52.0%) 13 (26.0%) 6 (12.0%) 5 (10.0%) 10 (20.8%) 20 (41.7%) 8 (16.7%) 10 (20.8%) < 0.001 Appropriate indications for CRS + HIPEC ( Fig. 1 ). The distribution of cancer types considered appropriate for CRS + HIPEC differed significantly between surgical and medical oncologists. Surgical oncologists were more likely to regard CRS + HIPEC as an appropriate option for gastric cancer (86.0% vs 41.7%, p = 0.000005), peritoneal mesothelioma (94.0% vs 54.2%, p = 0.000005), appendiceal tumors/pseudomyxoma peritonei (98.0% vs 79.2%, p = 0.0035), and colorectal cancer (90.0% vs 70.8%, p = 0.016). No statistically significant differences were observed for primary peritoneal (p = 0.15), ovarian (p = 0.68), pancreatic (p = 1.00), hepatocellular (p = 1.00), or gallbladder cancer (p = 0.61). These findings indicate that surgical oncologists perceived CRS + HIPEC as a viable treatment for a broader range of gastrointestinal and peritoneal malignancies compared with medical oncologists (Fig. 1 ). Perceived benefit of CRS + HIPEC ( Fig. 2 ). Likert-scale ratings (1 = not beneficial – 5 = definitely beneficial) revealed that surgical oncologists assigned significantly higher benefit scores for most cancer types. Marked differences were seen for peritoneal mesothelioma (4.28 ± 0.7 vs 3.08 ± 0.8, p = 0.000014), colorectal cancer (3.86 ± 0.6 vs 3.21 ± 0.7, p = 0.0016), appendiceal tumors/pseudomyxoma peritonei (4.48 ± 0.5 vs 3.98 ± 0.6, p = 0.011), primary peritoneal cancer (4.14 ± 0.8 vs 3.63 ± 0.7, p = 0.021), gastric cancer (2.92 ± 0.9 vs 2.54 ± 0.8, p = 0.027), and gallbladder cancer (1.14 ± 0.3 vs 1.42 ± 0.4, p = 0.047). No significant differences were found for ovarian (4.10 vs 3.83, p = 0.18), hepatocellular (1.24 vs 1.40, p = 0.35), or pancreatic cancer (1.36 vs 1.40, p = 0.74). Overall, surgical oncologists tended to perceive a greater benefit from CRS + HIPEC, particularly for peritoneal mesothelioma and colorectal cancer, while both groups demonstrated strong consensus regarding the procedure’s efficacy in ovarian cancer (Fig. 2 ). No statistically significant differences were observed between surgical and medical oncologists regarding the impact of the PRODIGE-7 trial, the need for national CRS + HIPEC guidelines, institutional readiness, or future expectations for CRS + HIPEC implementation in Turkey (Table 3 ). Both groups expressed comparable views on multidisciplinary collaboration, decision-making processes, and the representation of CRS + HIPEC in national and international guidelines. Table 3 Comparison of responses between surgical and medical oncologists for additional survey items (non-significant items) Survey Item Response Medical Oncology (n, %) Surgical Oncology (n, %) p-value Is a national guideline or standardized protocol for CRS + HIPEC necessary? Yes No Undecided 43 (89.6%) 2 (4.2%) 3 (6.2%) 46 (92.0%) 1 (2.0%) 3 (6.0%) 0.821 Do you think your institution has sufficient infrastructure for CRS + HIPEC? Yes No Partially No opinion 26 (54.2%) 7 (14.6%) 15 (31.2%) 0 (0.0%) 31 (62.0%) 2 (4.0%) 16 (32.0%) 1 (2.0%) 0.240 How do you evaluate the collaboration between surgical and medical oncology teams on HIPEC? Adequate and regular collaboration Occasional collaboration Insufficient collaboration I don't know 23 (47.9%) 16 (33.3%) 6 (12.5%) 3 (6.2%) 23 (46.0%) 19 (38.0%) 8 (16.0%) 0 (0.0%) 0.320 Did the PRODIGE-7 trial change your clinical practice? No, it did not change my practice Yes, both agent and duration changed Yes, the agent used changed Yes, the duration I apply changed 22 (45.8%) 13 (27.1%) 8 (16.7%) 5 (10.4%) 14 (28.0%) 24 (48.0%) 6 (12.0%) 6 (12.0%) 0.146 How is CRS + HIPEC represented in national/international guidelines? Controversial Insufficient evidence Strongly recommended I don't know 42 (87.5%) 3 (6.2%) 3 (6.2%) 0 (0.0%) 35 (70.0%) 2 (4.0%) 11 (22.0%) 2 (4.0%) 0.061 Will the role of CRS + HIPEC in Turkish oncology practice increase over the next 10 years? Increase Decrease Stay the same 32 (66.7%) 5 (10.4%) 11 (22.9%) 42 (84.0%) 1 (2.0%) 7 (14.0%) 0.088 Discussion This nationwide survey revealed distinct differences between surgical and medical oncologists in their knowledge, training, and perceptions of CRS–HIPEC. Surgical oncologists reported greater familiarity and confidence with the procedure, supported by higher participation in HIPEC training (78% vs 27%, p < 0.001) and stronger belief in its survival benefit (p = 0.006). In contrast, medical oncologists had less exposure but showed more openness to multidisciplinary discussions, as participation in tumor boards correlated with more favorable perceptions of CRS–HIPEC efficacy (p = 0.032). The two groups also differed in perceived barriers—surgeons most often cited economic constraints, whereas medical oncologists emphasized a lack of high-quality evidence (p < 0.001). Overall, these findings highlight persistent gaps between disciplines and underscore the need for unified education and stronger multidisciplinary collaboration to harmonize practice nationwide. Previous surveys investigating attitudes toward CRS–HIPEC have predominantly focused on surgeons or specific tumor types, providing limited insight into the perspectives of medical oncologists [ 8 – 11 ]. Our study addresses this gap by including a balanced representation of both disciplines, thereby offering one of the few direct interspecialty comparisons. The consistent discrepancy observed between surgical and medical oncologists aligns with earlier reports, which indicated that institutional exposure and direct procedural involvement are key determinants of familiarity and confidence toward CRS–HIPEC [ 10 , 12 ]. The association between MDT participation and more favorable perceptions supports existing international recommendations—such as those of the 2022 PSOGI/RENAPE Consensus—that advocate structured, cross-disciplinary evaluation to enhance confidence, education, and guideline adherence [ 2 , 13 ]. Strengthening MDT culture across centers could therefore represent a low-cost, high-impact strategy to harmonize understanding and practice nationally. The observed disparity in HIPEC training highlights the absence of standardized educational frameworks across institutions. Currently, procedural expertise is concentrated within a limited number of high-volume centers, restricting broader knowledge dissemination and multidisciplinary competence. International consensus statements, including the PSOGI/RENAPE and ESMO/NCCN guidelines, emphasize the need for structured training programs, institutional accreditation, and coordinated multidisciplinary governance to ensure the safe and effective implementation of CRS–HIPEC [ 2 , 6 ]. Establishing a unified, competency-based training and certification model—jointly supported by surgical and medical oncology communities—could facilitate equitable skill development, strengthen interinstitutional collaboration, and promote consistent standards of care across diverse healthcare settings. The PRODIGE-7 trial challenged conventional HIPEC practice by showing no overall survival benefit for short-duration oxaliplatin-based perfusion, despite increased late morbidity [ 14 ]. Subsequent analyses attributed this neutral outcome to protocol limitations, while registry and phase-II data demonstrated benefit in selected patients with low PCI and complete cytoreduction. Newer regimens such as irinotecan-based (EFFIPEC), mitomycin-C (HIPECT4), and integrated FOLFOX protocols have further refined practice [ 15 ]. The 2021 PSOGI web survey reported that nearly half of centers modified their regimen post-PRODIGE-7 [ 12 ]. In our cohort, 45.8% of surgeons reported no change after PRODIGE-7, whereas 72% of medical oncologists altered their regimen or duration, reflecting greater responsiveness to new evidence among medical oncologists and stronger procedural consistency among surgeons. Beyond structural factors, these interspecialty differences also reflect distinct professional paradigms. Surgical oncologists are directly involved in cytoreductive procedures and perioperative management, which reinforces procedural familiarity and a stronger sense of therapeutic ownership. In contrast, medical oncologists typically evaluate HIPEC through the lens of systemic therapy, where evidence from randomized trials remains limited [ 16 ]. Consequently, surgeons may perceive CRS–HIPEC as a logical extension of curative surgery for selected patients, while medical oncologists approach it with greater caution and data-driven restraint. Such professional divergence has also been noted in recent clinician-perspective analyses emphasizing the importance of multidisciplinary interpretation and shared decision-making [ 17 ]. Maintaining balance between experiential confidence and evidence-based prudence within multidisciplinary discussions is therefore crucial to prevent both therapeutic inertia and procedural overenthusiasm. Despite some non-significant findings, the survey revealed broad agreement on the strategic importance of CRS–HIPEC in contemporary oncology practice. Nearly all participants supported the development of standardized national guidelines or treatment protocols (≈ 90%), and more than half reported that their institutional infrastructure was adequate for implementation. Collaboration between disciplines was generally rated as satisfactory, and both groups regarded CRS–HIPEC as a procedure with evolving evidence but promising potential in appropriately selected patients. Most respondents anticipated an expanding role for CRS–HIPEC over the next decade, reflecting shared optimism and a growing drive toward standardization and multidisciplinary integration. This study has several limitations. As a cross-sectional, self-reported survey, it may be affected by recall bias and cannot infer causality between experience and attitudes. Although participation was nationwide, the modest sample size (n = 98) may not represent all oncology centers, with tertiary institutions slightly overrepresented. Some items, such as “adequate infrastructure,” were based on subjective interpretation. Finally, the perception-based findings reflect professional awareness rather than clinical outcomes. Future multicenter registry studies integrating objective performance data could validate and extend these insights. Conclusion Surgical oncologists perceive greater benefit from CRS–HIPEC, whereas multidisciplinary collaboration enhances acceptance among medical oncologists. National training initiatives, stronger MDT integration, and unified guidelines are essential to harmonize practice and strengthen the multidisciplinary foundation of CRS–HIPEC. Declarations Author Contributions Conceptualization, E.G. and A.O.; Methodology, E.G., A.O. and V.S.; Formal Analysis, E.G.; Investigation, S.B., C.Ö., and N.A.; Data Curation, V.S., Ö.T., and S.B.; Writing—Original Draft Preparation, E.G.; Writing—Review & Editing, A.O., V.S., and T.Ç.; Visualization, E.G. and A.O.; Supervision, A.O. and T.Ç.; Project Administration, E.G. and A.O. All authors have read and agreed to the published version of the manuscript. Funding This research received no external funding. Institutional Review Board Statement Ethical approval was obtained from the Mersin University Clinical Research Ethics Committee (Decision No: 2025/1128). Informed Consent Statement Informed consent was obtained from all participants prior to their voluntary completion of the survey. The survey included an introductory statement outlining the study objectives, confidentiality, and data use, and consent was confirmed electronically before participation. Data Availability Statement Data are available from the corresponding author upon reasonable request. Conflicts of Interest The authors declare no conflicts of interest. Clinical trial registration – N/A (This study is a retrospective analysis and does not require trial registration). Reporting guideline – This study follows the STROBE reporting guideline for cross-sectional observational studies. References -Karimi, M., Shirsalimi, N. & Sedighi, E. Challenges following CRS and HIPEC surgery in cancer patients with peritoneal metastasis: a comprehensive review of clinical outcomes. Front. Surg. 11 , 1498529. 10.3389/fsurg.2024.1498529 (2024). PMID: 39687325; PMCID: PMC11647005. -Kusamura, S. et al. Review of 2022 PSOGI/RENAPE Consensus on HIPEC. J. Surg. Oncol. 130 (6), 1290–1298. 10.1002/jso.27885 (2024). 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Towards Equal Access to Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy and Survival in Patients with Isolated Colorectal Peritoneal Metastases: A Nationwide Population-Based Study. Ann. Surg. Oncol. 31 (6), 3758–3768. 10.1245/s10434-024-15131-0 (2024). Epub 2024 Mar 7. PMID: 38453767; PMCID: PMC11076384. -Quénet, F. et al.. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. ;22(2):256–266. doi: 10.1016/S1470-2045(20)30599-4. Epub 2021 Jan 18. PMID: 33476595. (2021). -Cashin, P. & Sugarbaker, P. H. Hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal peritoneal metastases: lessons learned from PRODIGE 7. J. Gastrointest. Oncol. 12 (Suppl 1), S120–S128. 10.21037/jgo-2020-05 (2021). PMID: 33968432; PMCID: PMC8100699. -Ostrowski, T. et al. A Clinician's perspective on the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer management. Surg. Oncol. 56 , 102117. 10.1016/j.suronc.2024.102117 (2024). -Kim, S. I. & Kim, J-W. Role of surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer. ESMO open. vol . 6 (3), 100149. 10.1016/j.esmoop.2021.100149 (2021). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Mar, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 04 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviews received at journal 25 Jan, 2026 Reviewers agreed at journal 25 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers invited by journal 20 Jan, 2026 Editor invited by journal 12 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 08 Dec, 2025 First submitted to journal 07 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8299416","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":578323187,"identity":"73730494-233d-44b3-b469-2eed36cdb510","order_by":0,"name":"Erkan 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00:33:24","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96933,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8299416/v1/fdc641468cc769513a3fb39e.html"},{"id":100929040,"identity":"336162d1-b638-41a8-a511-3b1d11e87ace","added_by":"auto","created_at":"2026-01-23 00:33:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80205,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of cancer types considered appropriate for CRS–HIPEC among surgical and medical oncologists.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8299416/v1/086d287ba6a7b3ec54ede404.png"},{"id":100929041,"identity":"b2cb3e96-017c-4a3d-8490-60fcb2e49e6d","added_by":"auto","created_at":"2026-01-23 00:33:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":78470,"visible":true,"origin":"","legend":"\u003cp\u003ePerceived benefit scores for CRS–HIPEC across cancer types comparing surgical and medical oncologists.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8299416/v1/ffdf872d85e47c5f3d0858ab.png"},{"id":104739913,"identity":"81873465-2163-4fd0-be69-1cd1c3bb76fe","added_by":"auto","created_at":"2026-03-16 16:13:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1056790,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8299416/v1/1b5bd697-58e0-4809-8070-6b51980dfa57.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Awareness and Attitudes Among Surgical and Medical Oncologists","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeritoneal surface malignancies (PSMs) represent a heterogeneous group of cancers involving the peritoneum, most commonly originating from gastrointestinal or gynecologic primaries. Historically, peritoneal metastasis was considered a terminal manifestation managed mainly with systemic chemotherapy and palliative surgery. Over the past two decades, however, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved outcomes by offering selected patients the potential for durable survival [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent consensus efforts, including the Peritoneal Surface Oncology Group International (PSOGI) and the French Rare Peritoneal Tumors Network (RENAPE 2022), together with major guidelines from the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN), emphasize that CRS\u0026thinsp;\u0026plusmn;\u0026thinsp;HIPEC should be performed only in experienced, high-volume centers following multidisciplinary tumor-board review [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Strongest evidence supports CRS-HIPEC in appendiceal tumors/pseudomyxoma peritonei and peritoneal mesothelioma, whereas its role in colorectal and ovarian metastases is limited to carefully selected patients [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. For gastric cancer, CRS-HIPEC remains investigational and is generally restricted to clinical trials [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these recommendations, real-world practice often diverges, reflecting institutional experience, patient selection differences, and variations in interdisciplinary coordination [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Prior survey-based studies have demonstrated substantial variability in clinician knowledge and attitudes toward CRS-HIPEC, particularly between surgical and medical oncologists, highlighting gaps in awareness and evidence-based adoption [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, most previous work has been surgeon-focused or limited to specific tumor types, leaving medical oncologists relatively underrepresented and broader HIPEC indications insufficiently evaluated [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study aims to address this gap by evaluating the knowledge, awareness, and attitudes of both surgical and medical oncologists toward CRS-HIPEC in T\u0026uuml;rkiye. With nearly equal participation from both groups, this nationwide analysis provides one of the few balanced multidisciplinary assessments and may support improved interdisciplinary education, communication, and guideline adherence in the management of peritoneal surface malignancy [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional, questionnaire-based study was conducted between July and December 2025 to assess the awareness and attitudes of Turkish oncologists toward cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The target population included physicians officially certified as Surgical Oncologists or Medical Oncologists by the Turkish Ministry of Health and the Council of Higher Education (Y\u0026Ouml;K). To ensure homogeneity, general or gastroenterologic surgeons without formal surgical oncology certification were excluded.\u003c/p\u003e \u003cp\u003eThe survey was distributed electronically through the Turkish Society of Surgical Oncology (TSSD) and the Turkish Society of Medical Oncology (TTOD) via official mailing lists and society WhatsApp groups. Follow-up phone or email invitations helped maintain balanced participation. In total, 98 certified oncologists (50 surgical, 48 medical) from tertiary university hospitals, training and research institutions, and comprehensive cancer centers across T\u0026uuml;rkiye completed the survey. Participation was voluntary and anonymous; incomplete or duplicate responses were excluded. The final cohort proportionally represented T\u0026uuml;rkiye\u0026rsquo;s subspecialized oncologic community.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eA structured 19-item questionnaire was developed based on prior studies [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and aligned with PSOGI and ESMO/NCCN recommendations. The items covered four domains:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e1. Demographics and professional background (experience, institution type, specialty, involvement in CRS-HIPEC cases),\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e2. Knowledge and attitudes toward CRS-HIPEC indications and survival benefit,\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e3. Institutional practice patterns (multidisciplinary board vs. individual decisions), and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e4. Awareness of guidelines and participation in HIPEC-related education.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eAll questions were multiple- or single-choice, with attitude statements rated on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree). The draft survey was reviewed by experts from both specialties and pilot-tested among ten oncologists for clarity and technical performance before nationwide dissemination.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics, version 29.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics summarized participant characteristics. Group comparisons between surgical and medical oncologists were conducted using the Chi-square or Fisher\u0026rsquo;s exact test as appropriate. Subgroup analysis evaluated the association between decision-making models (multidisciplinary board vs. individual physician) and perceptions of CRS-HIPEC survival benefit. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Mersin University Clinical Research Ethics Committee (No. 2025/1245) and conducted in accordance with the Declaration of Helsinki. All participants provided electronic informed consent, and no identifying data were collected.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 98 oncologists completed the survey (50 surgical oncologists, 48 medical oncologists) from tertiary university hospitals, training and research institutions, and comprehensive cancer centers across T\u0026uuml;rkiye. All participants held official subspecialty certification in either surgical or medical oncology. General or gastroenterologic surgeons without a formal surgical oncology title were intentionally excluded to ensure a homogeneous expert cohort.\u003c/p\u003e \u003cp\u003eThe sample reflects the proportional national distribution of certified subspecialists and provides a balanced expert representation at the national level (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the participants (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCategory\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecialty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (51.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (49.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears in oncology practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (29.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (26.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;16 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInstitution type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (42.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining and research hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState/City hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (23.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHIPEC performed in current institution\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, limited volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (54.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, routinely performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (36.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceived CRS\u0026ndash;HIPEC training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, formal course/training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (31.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, observership/rotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (46.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eValues are n (%). HIPEC = Hyperthermic Intraperitoneal Chemotherapy; CRS = Cytoreductive Surgery\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison Between Surgical and Medical Oncologists\u003c/h2\u003e \u003cp\u003eParticipation in HIPEC-related education or training was significantly higher among surgical oncologists (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Likewise, self-rated knowledge level on CRS\u0026thinsp;+\u0026thinsp;HIPEC (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and awareness of its indications (p\u0026thinsp;=\u0026thinsp;0.035) were also greater among surgical oncologists. The availability or routine performance of CRS\u0026thinsp;+\u0026thinsp;HIPEC at participants\u0026rsquo; institutions was more frequently reported by surgical oncologists (p\u0026thinsp;=\u0026thinsp;0.027), and they were more familiar with the number of CRS\u0026thinsp;+\u0026thinsp;HIPEC cases performed within the last year (p\u0026thinsp;=\u0026thinsp;0.002). Agreement with the statement \u0026ldquo;CRS\u0026thinsp;+\u0026thinsp;HIPEC improves survival in appropriate patients\u0026rdquo; was also stronger among surgical oncologists compared with medical oncologists (p\u0026thinsp;=\u0026thinsp;0.006). Among medical oncologists, subgroup analysis revealed that those indicating CRS\u0026thinsp;+\u0026thinsp;HIPEC decisions were made through a multidisciplinary tumor board were more likely to agree that the procedure improves survival in eligible patients (p\u0026thinsp;=\u0026thinsp;0.032), suggesting that participation in multidisciplinary decision-making may enhance confidence in CRS\u0026thinsp;+\u0026thinsp;HIPEC outcomes.\u003c/p\u003e \u003cp\u003eThe main barrier to CRS\u0026thinsp;+\u0026thinsp;HIPEC implementation also differed significantly between the groups; surgical oncologists most frequently identified economic costs, whereas medical oncologists more often cited the lack of evidence-based data (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of responses between surgical and medical oncologists (only significant items)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgical Oncology (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedical Oncology (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation in HIPEC-related education/training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObservation/internship\u003c/p\u003e \u003cp\u003eFormal course/training\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (30.0%)\u003c/p\u003e \u003cp\u003e24 (48.0%)\u003c/p\u003e \u003cp\u003e11 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (12.5%)\u003c/p\u003e \u003cp\u003e7 (14.6%)\u003c/p\u003e \u003cp\u003e35 (72.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-rated knowledge level on CRS\u0026thinsp;+\u0026thinsp;HIPEC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003eExpert\u003c/p\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (46.0%)\u003c/p\u003e \u003cp\u003e14 (28.0%)\u003c/p\u003e \u003cp\u003e13 (26.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (18.8%)\u003c/p\u003e \u003cp\u003e2 (4.2%)\u003c/p\u003e \u003cp\u003e29 (60.4%)\u003c/p\u003e \u003cp\u003e8 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness of indications for CRS\u0026thinsp;+\u0026thinsp;HIPEC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003ePartially\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (80.0%)\u003c/p\u003e \u003cp\u003e10 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (58.3%)\u003c/p\u003e \u003cp\u003e20 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRS\u0026thinsp;+\u0026thinsp;HIPEC performed in their institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegularly\u003c/p\u003e \u003cp\u003eLimited number\u003c/p\u003e \u003cp\u003eNot performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (44.0%)\u003c/p\u003e \u003cp\u003e27 (54.0%)\u003c/p\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (29.2%)\u003c/p\u003e \u003cp\u003e26 (54.2%)\u003c/p\u003e \u003cp\u003e8 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of number of CRS\u0026thinsp;+\u0026thinsp;HIPEC cases in past 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 cases\u003c/p\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003cp\u003e0 / Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (42.0%)\u003c/p\u003e \u003cp\u003e17 (34.0%)\u003c/p\u003e \u003cp\u003e10 (20.0%)\u003c/p\u003e \u003cp\u003e2 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (18.8%)\u003c/p\u003e \u003cp\u003e10 (20.8%)\u003c/p\u003e \u003cp\u003e14 (29.2%)\u003c/p\u003e \u003cp\u003e15 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelief that CRS\u0026thinsp;+\u0026thinsp;HIPEC improves survival in eligible patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly agree\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (46.0%)\u003c/p\u003e \u003cp\u003e21 (42.0%)\u003c/p\u003e \u003cp\u003e5 (10.0%)\u003c/p\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (16.7%)\u003c/p\u003e \u003cp\u003e27 (56.2%)\u003c/p\u003e \u003cp\u003e13 (27.1%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain barrier to CRS\u0026thinsp;+\u0026thinsp;HIPEC implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEconomic costs\u003c/p\u003e \u003cp\u003eLack of evidence-based data\u003c/p\u003e \u003cp\u003eLack of infrastructure\u003c/p\u003e \u003cp\u003eLack of experienced team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (52.0%)\u003c/p\u003e \u003cp\u003e13 (26.0%)\u003c/p\u003e \u003cp\u003e6 (12.0%)\u003c/p\u003e \u003cp\u003e5 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (20.8%)\u003c/p\u003e \u003cp\u003e20 (41.7%)\u003c/p\u003e \u003cp\u003e8 (16.7%)\u003c/p\u003e \u003cp\u003e10 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAppropriate indications for CRS\u0026thinsp;+\u0026thinsp;HIPEC (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe distribution of cancer types considered appropriate for CRS\u0026thinsp;+\u0026thinsp;HIPEC differed significantly between surgical and medical oncologists. Surgical oncologists were more likely to regard CRS\u0026thinsp;+\u0026thinsp;HIPEC as an appropriate option for gastric cancer (86.0% vs 41.7%, p\u0026thinsp;=\u0026thinsp;0.000005), peritoneal mesothelioma (94.0% vs 54.2%, p\u0026thinsp;=\u0026thinsp;0.000005), appendiceal tumors/pseudomyxoma peritonei (98.0% vs 79.2%, p\u0026thinsp;=\u0026thinsp;0.0035), and colorectal cancer (90.0% vs 70.8%, p\u0026thinsp;=\u0026thinsp;0.016). No statistically significant differences were observed for primary peritoneal (p\u0026thinsp;=\u0026thinsp;0.15), ovarian (p\u0026thinsp;=\u0026thinsp;0.68), pancreatic (p\u0026thinsp;=\u0026thinsp;1.00), hepatocellular (p\u0026thinsp;=\u0026thinsp;1.00), or gallbladder cancer (p\u0026thinsp;=\u0026thinsp;0.61). These findings indicate that surgical oncologists perceived CRS\u0026thinsp;+\u0026thinsp;HIPEC as a viable treatment for a broader range of gastrointestinal and peritoneal malignancies compared with medical oncologists (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003ePerceived benefit of CRS\u0026thinsp;+\u0026thinsp;HIPEC (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eLikert-scale ratings (1\u0026thinsp;=\u0026thinsp;not beneficial \u0026ndash; 5\u0026thinsp;=\u0026thinsp;definitely beneficial) revealed that surgical oncologists assigned significantly higher benefit scores for most cancer types. Marked differences were seen for peritoneal mesothelioma (4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 vs 3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8, p\u0026thinsp;=\u0026thinsp;0.000014), colorectal cancer (3.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 vs 3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7, p\u0026thinsp;=\u0026thinsp;0.0016), appendiceal tumors/pseudomyxoma peritonei (4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 vs 3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6, p\u0026thinsp;=\u0026thinsp;0.011), primary peritoneal cancer (4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 vs 3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7, p\u0026thinsp;=\u0026thinsp;0.021), gastric cancer (2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 vs 2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8, p\u0026thinsp;=\u0026thinsp;0.027), and gallbladder cancer (1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 vs 1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4, p\u0026thinsp;=\u0026thinsp;0.047). No significant differences were found for ovarian (4.10 vs 3.83, p\u0026thinsp;=\u0026thinsp;0.18), hepatocellular (1.24 vs 1.40, p\u0026thinsp;=\u0026thinsp;0.35), or pancreatic cancer (1.36 vs 1.40, p\u0026thinsp;=\u0026thinsp;0.74). Overall, surgical oncologists tended to perceive a greater benefit from CRS\u0026thinsp;+\u0026thinsp;HIPEC, particularly for peritoneal mesothelioma and colorectal cancer, while both groups demonstrated strong consensus regarding the procedure\u0026rsquo;s efficacy in ovarian cancer (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNo statistically significant differences were observed between surgical and medical oncologists regarding the impact of the PRODIGE-7 trial, the need for national CRS\u0026thinsp;+\u0026thinsp;HIPEC guidelines, institutional readiness, or future expectations for CRS\u0026thinsp;+\u0026thinsp;HIPEC implementation in Turkey (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Both groups expressed comparable views on multidisciplinary collaboration, decision-making processes, and the representation of CRS\u0026thinsp;+\u0026thinsp;HIPEC in national and international guidelines.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of responses between surgical and medical oncologists for additional survey items (non-significant items)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical Oncology (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical Oncology (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs a national guideline or standardized protocol for CRS\u0026thinsp;+\u0026thinsp;HIPEC necessary?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eUndecided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (89.6%)\u003c/p\u003e \u003cp\u003e2 (4.2%)\u003c/p\u003e \u003cp\u003e3 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (92.0%)\u003c/p\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003cp\u003e3 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you think your institution has sufficient infrastructure for CRS\u0026thinsp;+\u0026thinsp;HIPEC?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003ePartially\u003c/p\u003e \u003cp\u003eNo opinion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (54.2%)\u003c/p\u003e \u003cp\u003e7 (14.6%)\u003c/p\u003e \u003cp\u003e15 (31.2%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (62.0%)\u003c/p\u003e \u003cp\u003e2 (4.0%)\u003c/p\u003e \u003cp\u003e16 (32.0%)\u003c/p\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow do you evaluate the collaboration between surgical and medical oncology teams on HIPEC?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate and regular collaboration\u003c/p\u003e \u003cp\u003eOccasional collaboration\u003c/p\u003e \u003cp\u003eInsufficient collaboration\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (47.9%)\u003c/p\u003e \u003cp\u003e16 (33.3%)\u003c/p\u003e \u003cp\u003e6 (12.5%)\u003c/p\u003e \u003cp\u003e3 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (46.0%)\u003c/p\u003e \u003cp\u003e19 (38.0%)\u003c/p\u003e \u003cp\u003e8 (16.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid the PRODIGE-7 trial change your clinical practice?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, it did not change my practice\u003c/p\u003e \u003cp\u003eYes, both agent and duration changed\u003c/p\u003e \u003cp\u003eYes, the agent used changed\u003c/p\u003e \u003cp\u003eYes, the duration I apply changed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (45.8%)\u003c/p\u003e \u003cp\u003e13 (27.1%)\u003c/p\u003e \u003cp\u003e8 (16.7%)\u003c/p\u003e \u003cp\u003e5 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (28.0%)\u003c/p\u003e \u003cp\u003e24 (48.0%)\u003c/p\u003e \u003cp\u003e6 (12.0%)\u003c/p\u003e \u003cp\u003e6 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow is CRS\u0026thinsp;+\u0026thinsp;HIPEC represented in national/international guidelines?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControversial\u003c/p\u003e \u003cp\u003eInsufficient evidence\u003c/p\u003e \u003cp\u003eStrongly recommended\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (87.5%)\u003c/p\u003e \u003cp\u003e3 (6.2%)\u003c/p\u003e \u003cp\u003e3 (6.2%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (70.0%)\u003c/p\u003e \u003cp\u003e2 (4.0%)\u003c/p\u003e \u003cp\u003e11 (22.0%)\u003c/p\u003e \u003cp\u003e2 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill the role of CRS\u0026thinsp;+\u0026thinsp;HIPEC in Turkish oncology practice increase over the next 10 years?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncrease\u003c/p\u003e \u003cp\u003eDecrease\u003c/p\u003e \u003cp\u003eStay the same\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (66.7%)\u003c/p\u003e \u003cp\u003e5 (10.4%)\u003c/p\u003e \u003cp\u003e11 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (84.0%)\u003c/p\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003cp\u003e7 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis nationwide survey revealed distinct differences between surgical and medical oncologists in their knowledge, training, and perceptions of CRS\u0026ndash;HIPEC. Surgical oncologists reported greater familiarity and confidence with the procedure, supported by higher participation in HIPEC training (78% vs 27%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and stronger belief in its survival benefit (p\u0026thinsp;=\u0026thinsp;0.006). In contrast, medical oncologists had less exposure but showed more openness to multidisciplinary discussions, as participation in tumor boards correlated with more favorable perceptions of CRS\u0026ndash;HIPEC efficacy (p\u0026thinsp;=\u0026thinsp;0.032). The two groups also differed in perceived barriers\u0026mdash;surgeons most often cited economic constraints, whereas medical oncologists emphasized a lack of high-quality evidence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Overall, these findings highlight persistent gaps between disciplines and underscore the need for unified education and stronger multidisciplinary collaboration to harmonize practice nationwide.\u003c/p\u003e \u003cp\u003ePrevious surveys investigating attitudes toward CRS\u0026ndash;HIPEC have predominantly focused on surgeons or specific tumor types, providing limited insight into the perspectives of medical oncologists [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our study addresses this gap by including a balanced representation of both disciplines, thereby offering one of the few direct interspecialty comparisons. The consistent discrepancy observed between surgical and medical oncologists aligns with earlier reports, which indicated that institutional exposure and direct procedural involvement are key determinants of familiarity and confidence toward CRS\u0026ndash;HIPEC [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The association between MDT participation and more favorable perceptions supports existing international recommendations\u0026mdash;such as those of the 2022 PSOGI/RENAPE Consensus\u0026mdash;that advocate structured, cross-disciplinary evaluation to enhance confidence, education, and guideline adherence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Strengthening MDT culture across centers could therefore represent a low-cost, high-impact strategy to harmonize understanding and practice nationally.\u003c/p\u003e \u003cp\u003eThe observed disparity in HIPEC training highlights the absence of standardized educational frameworks across institutions. Currently, procedural expertise is concentrated within a limited number of high-volume centers, restricting broader knowledge dissemination and multidisciplinary competence. International consensus statements, including the PSOGI/RENAPE and ESMO/NCCN guidelines, emphasize the need for structured training programs, institutional accreditation, and coordinated multidisciplinary governance to ensure the safe and effective implementation of CRS\u0026ndash;HIPEC [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Establishing a unified, competency-based training and certification model\u0026mdash;jointly supported by surgical and medical oncology communities\u0026mdash;could facilitate equitable skill development, strengthen interinstitutional collaboration, and promote consistent standards of care across diverse healthcare settings.\u003c/p\u003e \u003cp\u003eThe PRODIGE-7 trial challenged conventional HIPEC practice by showing no overall survival benefit for short-duration oxaliplatin-based perfusion, despite increased late morbidity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Subsequent analyses attributed this neutral outcome to protocol limitations, while registry and phase-II data demonstrated benefit in selected patients with low PCI and complete cytoreduction. Newer regimens such as irinotecan-based (EFFIPEC), mitomycin-C (HIPECT4), and integrated FOLFOX protocols have further refined practice [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The 2021 PSOGI web survey reported that nearly half of centers modified their regimen post-PRODIGE-7 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our cohort, 45.8% of surgeons reported no change after PRODIGE-7, whereas 72% of medical oncologists altered their regimen or duration, reflecting greater responsiveness to new evidence among medical oncologists and stronger procedural consistency among surgeons.\u003c/p\u003e \u003cp\u003eBeyond structural factors, these interspecialty differences also reflect distinct professional paradigms. Surgical oncologists are directly involved in cytoreductive procedures and perioperative management, which reinforces procedural familiarity and a stronger sense of therapeutic ownership. In contrast, medical oncologists typically evaluate HIPEC through the lens of systemic therapy, where evidence from randomized trials remains limited [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Consequently, surgeons may perceive CRS\u0026ndash;HIPEC as a logical extension of curative surgery for selected patients, while medical oncologists approach it with greater caution and data-driven restraint. Such professional divergence has also been noted in recent clinician-perspective analyses emphasizing the importance of multidisciplinary interpretation and shared decision-making [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Maintaining balance between experiential confidence and evidence-based prudence within multidisciplinary discussions is therefore crucial to prevent both therapeutic inertia and procedural overenthusiasm.\u003c/p\u003e \u003cp\u003e Despite some non-significant findings, the survey revealed broad agreement on the strategic importance of CRS\u0026ndash;HIPEC in contemporary oncology practice. Nearly all participants supported the development of standardized national guidelines or treatment protocols (\u0026asymp;\u0026thinsp;90%), and more than half reported that their institutional infrastructure was adequate for implementation. Collaboration between disciplines was generally rated as satisfactory, and both groups regarded CRS\u0026ndash;HIPEC as a procedure with evolving evidence but promising potential in appropriately selected patients. Most respondents anticipated an expanding role for CRS\u0026ndash;HIPEC over the next decade, reflecting shared optimism and a growing drive toward standardization and multidisciplinary integration.\u003c/p\u003e \u003cp\u003eThis study has several limitations. As a cross-sectional, self-reported survey, it may be affected by recall bias and cannot infer causality between experience and attitudes. Although participation was nationwide, the modest sample size (n\u0026thinsp;=\u0026thinsp;98) may not represent all oncology centers, with tertiary institutions slightly overrepresented. Some items, such as \u0026ldquo;adequate infrastructure,\u0026rdquo; were based on subjective interpretation. Finally, the perception-based findings reflect professional awareness rather than clinical outcomes. Future multicenter registry studies integrating objective performance data could validate and extend these insights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSurgical oncologists perceive greater benefit from CRS\u0026ndash;HIPEC, whereas multidisciplinary collaboration enhances acceptance among medical oncologists. National training initiatives, stronger MDT integration, and unified guidelines are essential to harmonize practice and strengthen the multidisciplinary foundation of CRS\u0026ndash;HIPEC.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, E.G. and A.O.; Methodology, E.G., A.O. and V.S.; Formal Analysis, E.G.; Investigation, S.B., C.Ö., and N.A.; Data Curation, V.S., Ö.T., and S.B.; Writing—Original Draft Preparation, E.G.; Writing—Review \u0026amp; Editing, A.O., V.S., and T.Ç.; Visualization, E.G. and A.O.; Supervision, A.O. and T.Ç.; Project Administration, E.G. and A.O.\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Mersin University Clinical Research Ethics Committee (Decision No: 2025/1128).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants prior to their voluntary completion of the survey. The survey included an introductory statement outlining the study objectives, confidentiality, and data use, and consent was confirmed electronically before participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e – N/A (This study is a retrospective analysis and does not require trial registration).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting guideline\u003c/strong\u003e – This study follows the STROBE reporting guideline for cross-sectional observational studies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e-Karimi, M., Shirsalimi, N. \u0026amp; Sedighi, E. 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Hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal and appendiceal peritoneal metastases: lessons learned from PRODIGE 7. \u003cem\u003eJ. Gastrointest. Oncol.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (Suppl 1), S120\u0026ndash;S128. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/jgo-2020-05\u003c/span\u003e\u003cspan address=\"10.21037/jgo-2020-05\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021). PMID: 33968432; PMCID: PMC8100699.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e-Ostrowski, T. et al. A Clinician's perspective on the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer management. \u003cem\u003eSurg. Oncol.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e, 102117. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.suronc.2024.102117\u003c/span\u003e\u003cspan address=\"10.1016/j.suronc.2024.102117\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e-Kim, S. I. \u0026amp; Kim, J-W. Role of surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer. \u003cem\u003eESMO open. vol\u003c/em\u003e. \u003cb\u003e6\u003c/b\u003e (3), 100149. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.esmoop.2021.100149\u003c/span\u003e\u003cspan address=\"10.1016/j.esmoop.2021.100149\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cytoreductive surgery (CRS), Hyperthermic intraperitoneal chemotherapy (HIPEC), Medical oncology, Multidisciplinary decision-making, Surgical oncology","lastPublishedDoi":"10.21203/rs.3.rs-8299416/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8299416/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an established treatment for selected peritoneal surface malignancies. However, awareness, training exposure, and attitudes toward CRS–HIPEC vary among oncologic disciplines. This nationwide study aimed to assess and compare the knowledge, awareness, and perceptions of surgical and medical oncologists in Türkiye regarding CRS–HIPEC indications, benefits, and implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional, web-based survey was conducted between July and December \u0026nbsp;2025 among certified surgical and medical oncologists. A 19-item questionnaire evaluated demographics, CRS–HIPEC training, institutional practices, and attitudes using a five-point Likert scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNinety-eight oncologists (50 surgical, 48 medical) participated nationwide. HIPEC-related training (p \u0026lt; 0.001), self-rated knowledge (p \u0026lt; 0.001), and awareness of indications (p = 0.035) were significantly higher among surgical oncologists. Agreement with “CRS–HIPEC improves survival in appropriate patients” was stronger in the surgical group (p = 0.006). Among medical oncologists, those participating in multidisciplinary tumor boards were more likely to agree with the survival benefit (p = 0.032). Overall, 92% of participants supported the need for a national CRS–HIPEC guideline or standardized protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurgical oncologists report greater training exposure and stronger belief in the benefit of CRS–HIPEC; however, multidisciplinary collaboration enhances understanding and acceptance among medical oncologists. Unified national guidelines and structured training programs may help align perspectives and optimize multidisciplinary practice.\u003c/p\u003e","manuscriptTitle":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Awareness and Attitudes Among Surgical and Medical Oncologists","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 00:33:19","doi":"10.21203/rs.3.rs-8299416/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-04T07:41:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T10:28:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T00:42:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164011761193500419855846763720813937588","date":"2026-01-26T00:27:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170081062941982273866323249862912078698","date":"2026-01-23T22:51:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36027778810468347930475152601371155878","date":"2026-01-22T22:04:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67736294286251094951986863245730155179","date":"2026-01-21T08:06:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246061286060540620534408016916905726708","date":"2026-01-20T13:09:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T07:07:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-12T17:29:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T05:46:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-08T05:43:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-07T11:13:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93606f9a-71bf-4ab3-8fd4-4d21ebe854a7","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":61534521,"name":"Biological sciences/Cancer"},{"id":61534522,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2026-03-16T16:08:39+00:00","versionOfRecord":{"articleIdentity":"rs-8299416","link":"https://doi.org/10.1038/s41598-026-43750-y","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-03-10 16:00:30","publishedOnDateReadable":"March 10th, 2026"},"versionCreatedAt":"2026-01-23 00:33:19","video":"","vorDoi":"10.1038/s41598-026-43750-y","vorDoiUrl":"https://doi.org/10.1038/s41598-026-43750-y","workflowStages":[]},"version":"v1","identity":"rs-8299416","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8299416","identity":"rs-8299416","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}