open access: Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy in the Treatment of Advanced Epithelial Ovarian Cancer

 Background/Aims.
Intraperitoneal intraoperative hyperthermic chemotherapy (HIPEC) has been used in the treatment of ovarian cancer. The purpose of the study is to determine the efficacy of HIPEC after cytoreductive surgery in advanced ovarian cancer

 From 2006 to 2010, 43 women with primary or recurrent ovarian cancer were enrolled in the study and underwent maximal cytoreductive surgery and HIPEC. The mean age of the patients was 59.9 yrs (16–82) years.

Table 1: Characteristics of the patients.

Table 2: Peritonectomy procedures.

Table 3: Complications ( 6 grade 111/1V events)
"...Severe morbidity (grade 3 and 4) has been recorded in 6 patients (14%). It is obvious that the most severe complication is the anastomotic failure. Anastomotic failure has been reported in other series as the most frequent complication [8, 9, 25]. Cisplatin has been incriminated to impair anastomotic healing in animal studies [26] in contrast to local hyperthermia that has not [27]. As a consequence, the failures may be attributed either to cisplatin or to the immediate restoration of the gastrointestinal tract after low-anterior resection particularly in those cases with preoperative partial intestinal obstruction. The importance of intestinal obstruction and the avoidance of immediate restoration of the gastrointestinal tract has been emphasized [9] resulting in significant decrease of anastomotic failures [28]. Therefore a protective colostomy seems to be a reasonable solution. Other severe complications as intra-abdominal abscess or sepsis or postoperative bleeding are infrequent [8, 9, 25]....."


Conclusions
Maximal cytoreductive surgery with standard peritonectomy procedures combined with intraperitoneal chemotherapy is a well-tolerated and feasible method for treatment of advanced epithelial ovarian cancer. It appears to improve long-term survival securing that complete or near complete cytoreduction is possible in the vast majority as well as the eradication of the microscopic residual tumor.