Can EPIC Be a Low-Cost Alternative to HIPEC in Advanced Epithelial Ovarian Cancer in Resource-Constraint Settings? Experience from Tertiary Care Oncology Center.

Abstract

Management of advanced ovarian cancer underwent a paradigm shift with advent of cytoreductive surgery and intraperitoneal chemotherapy. Hyperthermic intraperitoneal chemotherapy requires complex machinery and costly disposables, and increased operative time. Early postoperative intraperitoneal chemotherapy is a relatively less resource-intensive alternative way of intraperitoneal drug delivery. We started our HIPEC programme in 2013. In select cases, we offer EPIC. This study is an audit of outcomes to look into the feasibility of EPIC as alternative to HIPEC. We performed analysis of prospectively maintained database in the Department of Surgical oncology from January 2019 to June 2022. We had 15 patients who underwent CRS + EPIC and 84 CRS+ HIPEC. We did a propensity-matched analysis for demographics, baseline data and PCI and compared 15 CRS + EPIC with 15 CRS + HIPEC patients. We compared the perioperative outcomes-morbidity, mortality, length of ICU and hospital stay. Procedure time was significantly higher in the HIPEC compared to EPIC as HIPEC is an intraoperative procedure. Patients were admitted to intensive care unit (ICU) after surgery for a longer mean duration in HIPEC arm (1.4 + 0.7 days) compared to EPIC arm (1.2 + 0.41 days). Patients in HIPEC arm had a significantly shorter hospital stay (mean 7.93 vs. 9.93 days. Four patients in EPIC arm had Clavien-Dindo grade 3 and 4 morbidity compared to 1 patient in HIPEC arm. Hematological toxicity was more common in EPIC group. CRS with EPIC can be explored as an alternative to HIPEC in centres lacking facilities and expertise for HIPEC.