Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy in Recurrent Ovarian Cancer

Abstract

Secondary cytoreduction with intraperitoneal chemotherapy is feasible in most women with recurrent ovarian cancer with acceptable morbidity and mortality. Complete cytoreduction is not possible if distant and unresectable metastases are present or if the small bowel is extensively seeded. Long-term survivors are patients with limited peritoneal dissemination who may undergo complete cytoreduction.

Combined Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Advanced Ovarian Cancer

“…The rate of postoperative complications in cytoreductive surgery combined with HIPEC does not usually exceed 30-35% although a morbidity rate of 54% has been referred in one study (Elias et al, 2001). The same high rate of morbidity has been recorded in patients with ovarian cancer treated with cytoreduction and perioperative intraperitoneal chemotherapy Tentes et al, 2006;Raspagliesi et al, 2006;Di Giorgio et al, 2008;Tentes et al, 2010). In properly selected patients the mortality rate is not high and does not exceed 5% (Piso et al, 2004;Raspagliesi et al, 2006;Tentes et al, 2010).…”

“…The same high rate of morbidity has been recorded in patients with ovarian cancer treated with cytoreduction and perioperative intraperitoneal chemotherapy Tentes et al, 2006;Raspagliesi et al, 2006;Di Giorgio et al, 2008;Tentes et al, 2010). In properly selected patients the mortality rate is not high and does not exceed 5% (Piso et al, 2004;Raspagliesi et al, 2006;Tentes et al, 2010). However, if the patients are not properly selected the mortality rate increases dramatically (Tentes et al, 2006).…”

“…The completeness of cytoreduction, and the extent of peritoneal dissemination are consistently found to be significant prognostic indicators of survival Piso et al, 2004;Gilly et al, 2006;Di Giorgio et al, 2008;Tentes et al, 2010;Zanon et al, 2004;Rufian et al, 2006). Prior surgical score has been identified as a prognostic indicator of survival in one study (Look et al, 2004).…”

“…Prior surgical score has been identified as a prognostic indicator of survival in one study (Look et al, 2004). Median and 5-year survival rate varies from 18-54 months and 12-66% respectively (Piso et al, 2004;Raspagliesi et al, 2006;Di Giorgio et al, 2008;Tentes et al 2010, Ryu et al, 2004Zanon et al, 2004;Rufian et al, 2006;de Bree et al, 2003;Bae et al, 2007;Ceelen et al, 2009) ( Table 2). All these studies are prospective but not randomized (evidence level 4) and demonstrate that the method is feasible, well tolerated by the patients, and the results are equivalent or even improved if compared to historical data.…”

“…The incidence of recurrence is high in ovarian cancer and varies from 42-48% (Di Giorgio et al, 2008;Tentes et al, 2010). The majority of recurrences are loco-regional.…”