Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Epithelial Ovarian Cancer: A 20-Year Single-Center Experience

SIMPLE SUMMARY: Multimodality treatment is the standard treatment for epithelial ovarian cancer, but the peritoneum is the primary site of spread or relapse in most cases. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been introduced in order to improve outcomes, but most studies, including both primary and recurrent cases, are retrospective, non-randomized and heterogeneous. The aim of this study was to report a 20-year single-center experience with this treatment. In our study, it appeared to be a feasible procedure, with acceptable postoperative morbidity and mortality rates, providing different survival benefits depending on the timing of surgery, as long as a complete cytoreduction was obtained. Until the results from ongoing prospective randomized clinical trials clarify the role and appropriate indications, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may be considered an effective treatment for selected cases of epithelial ovarian cancer, if performed in specialized centers. ABSTRACT: Despite improvement in treatments, the peritoneum remains the primary site of relapse in most ovarian cancer cases. Patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from epithelial ovarian cancer were reviewed. Kaplan–Meier curves and multivariate Cox analyses were used to identify survival rates and prognostic factors. This study included 158 patients. The procedure was mostly performed for recurrent disease (46.8%) and high-grade serous carcinoma (58.2%). The median peritoneal cancer index was 14, and complete cytoreduction was obtained in 87.9% of cases. Grade IV morbidity occurred in 15.2% of patients, mostly requiring surgical reoperation, and one patient (0.6%) died within 90 days. The median follow-up was 63.5 months. The Kaplan–Meier 5-year overall survival (OS) and disease-free survival (DFS) rates were 42.1% and 24.3%, respectively. Multiple regression logistic analyses demonstrated that the completeness of cytoreduction (CC) score (p ≤ 0.0001), pancreatic resection (p ≤ 0.0001) and number of resections (p = 0.001) were significant factors influencing OS; whereas the CC score (p ≤ 0.0001) and diaphragmatic procedures (p = 0.01) were significant for DFS. The addition of hyperthermic intraperitoneal chemotherapy to standard multimodality therapy may improve outcomes in both primary and recurrent epithelial ovarian cancer without impairing early postoperative results, but the exact timing has not yet been established. Prospective randomized studies will clarify the role and indications of this approach.