Complications of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Advanced Ovarian Malignancies: First Indian Study

Abstract

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) has been proposed as a treatment for advanced ovarian carcinoma and pseudomyxoma peritonii. We analyzed the perioperative complications of extensive CRS + HIPEC in Indian patients with advanced ovarian malignancies and pseudomyxoma peritonii. In this prospective observational study, we included 38 patients from February 2013 to June 2015 with advanced EOC and pseudomyxoma peritonii treated by a dedicated peritoneal malignant disease treatment team in a tertiary care hospital. All patients underwent extensive CRS + HIPEC. The post-operative morbidity and mortality were analyzed. Our patients were grouped into frontline 21.1 % (n = 8), interval cytoreduction 50 % (n = 19), and secondary cytoreduction 28.9 % (n = 11) based on the timeline at presentation. Mean peritoneal carcinomatosis index (PCI) was 8.5 ± 7.45 (range 3–36). Average surgery duration was 9 ± 2.7 h (range 5.5–19). Mean perfusion temperature used was (42 ± 0.49 °C). Patients with PCI score ≥15 had prolonged gastrointestinal recovery (p = 0.043), post-operative ventilator need (p = 0.011), acute respiratory distress syndrome (ARDS) (p = 0.014), and dyspnea (p = 0.002) with trend towards adverse events. Closed method HIPEC was associated with prolonged hospital stay (p = 0.011), wound-related complications (p = 0.006), and ARDS (p < 0.001). Multivisceral resections were associated with increased ventilator need (p < 0.001), ARDS (p = 0.010), and adverse events (p = 0.044). The recurrent ovarian carcinomas were associated with more wound-related complications (p = 0.016). More adverse events with cisplatin 100 mg/m2 (p = 0.03) were dyselectrolytemia, acute renal failure, and fall in hemoglobin. No 30-day mortality was present. After a median follow-up of 17 (3–28) months, 15.8 % patients (n = 6) had recurrences and 5.3 % (n = 2) succumbed to disease. Ovarian peritoneal malignancies known for peritoneal recurrences are amenable for extensive cytoreduction and HIPEC with acceptable morbidity in Indian patients. A dedicated team of surgeon, anesthetist, medical oncologist, and intensivist is mandatory for better outcome.