Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent ovarian carcinoma: analysis of 30-day morbidity and mortality.

Abstract

The aim of this study was to evaluate morbidity and mortality associated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with ovarian, fallopian tube, and primary peritoneal cancer. A retrospective review of patients undergoing cytoreductive surgery plus HIPEC from 1 January 2007 to 29 July 2013 at two academic medical centers was performed. Grade 3/4 complications (National Cancer Institute's Common Toxicity Criteria version 4.0) from day of surgery until 30days postoperatively were recorded. Thirty-two patients were identified, with 27 cases of ovarian cancer, three primary peritoneal cancers, and two fallopian tube cancers. Indications included 24 at the time of cancer recurrence, six at interval surgical resection, and two in the consolidative setting. Hyperthermic chemotherapeutic regimens included carboplatin (n=21), cisplatin (n=4), oxaliplatin (n=2), oxaliplatin+intravenous 5-fluorouracil (n=1), doxorubicin (n=1), and cisplatin+doxorubicin (n=1). Infusion time ranged from 30 to 90min, with a maximum temperature range of 41-43°C. The combined grade 3/4 morbidity rate was 65.6%, and the most frequent morbidities included grade 3 anemia (40.6%), infection (15.6%), and pleural effusion (12.5%). Six patients required readmission (18.8%), and two patients required reoperation (6.2%). Full-thickness diaphragm resection/peritoneal stripping had a significant association with grade 3/4 pleural effusions (p=0.0007). Cytoreductive surgery plus HIPEC is feasible in patients with ovarian cancer with 65.6% grade 3/4 morbidity and no deaths. Balancing these complications with potential survival benefits is important in centers considering implementing HIPEC protocols.