Laparoscopic HIPEC in the treatment of advanced ovarian cancer.

Abstract

HIPEC has been recently recommended as the 'new standard of care' for advanced ovarian cancer patients to treat residual disease, a recommendation based on the good results reported by many single institution studies. This study aims to elucidate whether cyto-reductive surgery for advanced stage IV ovarian cancer combined with laparoscopic HIPEC has any value in the management of advanced ovarian cancer. From January 2007 to October 2011, 31 patients with stage IV ovarian cancer were enrolled. The inclusion criteria were stage IV epithelial ovarian cancer, with no evidence of extra-abdominal metastasis, and without previous systemic chemotherapy. Patients were randomly divided into two groups, group A and group B, which consisted of 12 patients who received laparoscopic HIPEC in a neo-adjuvant setting, and 19 patients who received laparoscopic HIPEC in an adjuvant setting, respectively. Overall response rate after Laparoscopic HIPEC (neo-adjuvant and adjuvant) was 100%. Macroscopic images recorded during initial laparoscopy and subsequent laparoscopies revealed a dramatic decrease in the size of the neoplastic deposits accompanied with a decrease in their absolute number. The results of this study indicate that laparoscopic HIPEC preceding multi-organ radical surgery has been seen to be associated with optimal short and long-term results, and promising OS and DFS. They also demonstrate the therapeutical advantage of neo-adjuvant initial approach over adjuvant approach.