OBJECTIVE Failure to respond to systemic chemotherapy is considered an exclusion criterion by some institutions for treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). However, it is unknown if these patients benefit from HIPEC treatment. This study aimed to report on outcomes of HIPEC in patients who failed to respond to adjuvant systemic chemotherapy. METHODS Patients were selected from a prospective database containing data on all patients who underwent HIPEC, using the following criteria: (1) Metachronous peritoneal carcinomatosis (PC) from colorectal origin, (2) adjuvant chemotherapy after primary tumor resection, (3) development of PC or local recurrence within 18 months after start of chemotherapy. Treatment and survival data were retrospectively collected. RESULTS Twenty-one patients (29% male, mean age 57 years) were included. Median time to recurrence of disease was 9 months (range 2-15) after first chemotherapy administration. Median survival was 28 months (range 3-100). One- and 2-year survival were 71% and 43%, respectively. CONCLUSIONS Patients who initially failed to respond to systemic adjuvant treatment showed a survival after HIPEC similar to results reported in literature in patients with unknown responsiveness. Failure to respond to previous adjuvant systemic treatment should therefore not be considered an exclusion criterion for HIPEC treatment.