To study the outcome and role of cytoreductive surgery (CRS) + HIPEC in advanced upfront and recurrent epithelial ovarian cancer.
100 consecutive patients with advanced epithelial ovarian cancer diagnosed between January 2011 to January 2017 were included in study after informed consent. IRB ethical clearance was obtained. All patients underwent CRS followed by HIPEC with dedicated machine (PERFORMER-HT) using only cisplatin 45mg/l for upfront and cisplatin 45mg/l and adriamycin 15mg/l in recurrent cases for 90 minutes in semi-open technique at 42 degrees Celsius. Descriptive study statistical analysis was done.
Out of 100 patients, 74 were primary and 26 recurrent. Of 74 cases, 67.5% (n = 50) had upfront CRS+ HIPEC and 32.5% (n = 24) had interval CRS + HIPEC. Of 26 recurrent, 69.3% (n = 18) were platinum sensitive and 30.7% (n = 8) were platinum resistant. Median age 54.5(22-78) PCI 11.9(5-37) duration of surgery 9.5hrs (5-15),GI recovery 5.4 days, hospital stay 11.4 days. 12% (grade III) adverse morbidity and 3% 60 day mortality. Prolonged duration of surgery (p = 0.001), multivisceral resection (p = 0.039) hypoalbuminemia (p = 0.04) hypocalcemia (p = 0.01) were predictive factors for morbidity and prolonged hospital stay. With a median follow up of 50 months we had 6 systemic (3 lymph node, 2 bowel surface and 1 liver parenchyma) and 6 peritoneal recurrence and 7 deaths. Over all survival in primary was 70 months, platinum sensitive 32 months and platinum resistant 12 months.
CRS+HIPEC in advanced epithelial ovarian cancer can be done with accepted morbidity and mortality. Multivisceral resection, prolonged surgery, hypoalbuminemia, hypocalcemia were predictive factors for morbidity and prolonged hospital stay. Primary ovarian malignancies and platinum sensitive benefit the most with CRS + HIPEC whereas platinum resistant disease does not have any benefit.
Clinical trial identification
Legal entity responsible for the study
IRB ethical clerance, institional ethical board clerance
All authors have declared no conflicts of interest.