Peritonectomy and hyperthermic intraperitoneal chemotherapy for advanced epithelial ovarian cancer: What gynaecological oncologists really think.

Abstract

Peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) is used in specialised units outside of gynaecological cancer centres in Australia and New Zealand to treat advanced epithelial ovarian cancer (AEOC). There is significant equipoise toward this treatment by gynaecological oncologists (CGOs). To determine the attitudes and preferences of CGOs toward peritonectomy and HIPEC for the treatment of AEOC. A questionnaire was sent to all 53 CGOs in Australia and New Zealand asking their opinions about peritonectomy and HIPEC for the treatment of AEOC. Data collected included surgeon demographics, individual surgical practices, and willingness of CGOs to refer patients for peritonectomy or HIPEC. Potential factors influencing this decision were investigated using χ2 tests and logistic regression analysis. Response rate was 89%. While 68% of CGOs would refer a patient for peritonectomy, most cases would be recurrent tumour of borderline or mucinous histology. Only 13% would refer a case of primary stage 3 EOC, even if predicting they cannot completely resect the tumour. This was due to concerns around morbidity and mortality, and a preference for neoadjuvant chemotherapy. In regard to HIPEC, 61% of CGOs were unsure about its use, due to reported lack of evidence, and potential morbidity. CGOs of female gender were more likely to recommend peritonectomy and HIPEC. CGOs would refer only selected cases of AEOC for peritonectomy or HIPEC, due to concerns around insufficient evidence, and potential morbidity. The results of large well-conducted clinical trials will help determine the future of peritonectomy and HIPEC for the treatment of AEOC.