Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from ovarian cancer

BACKGROUND In selected patients with peritoneal carcinomatosis from ovarian cancer prognosis can be improved by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS Between September 1995 and February 1999, 19 patients (mean age 52 years, range 30-72 years) with peritoneal carcinomatosis from primary or recurrent epithelial ovarian carcinoma were operated with the aim of complete macroscopical cytoreduction. Surgery was followed by intraoperative HIPEC. The data was analyzed retrospectively. RESULTS Eleven patients had recurrent and 8 primary ovarian cancer. The median progression free interval was 18 months (range 6-36 months). Macroscopically complete cytoreduction was achieved in 9 patients. Cisplatin (n = 16) or mitoxantrone (n = 3) were used for the intraoperative chemotherapy. The median intraabdominal inflow temperature was 41.5 degrees C. Complications occurred in seven patients. Most frequent complications were anastomotic leakage (2/19) and intraabdominal abscess formation (2/19). One patient died postoperatively. The mean (+/- SD) overall survival time was 33(+/- 6) months with a 5-year survival rate of 15%. The survival was found to be influenced by the completeness of cytoreduction (44 +/- 11 vs. 25 +/- 6 months, p = 0.40), tumor volume (54 +/- 10 versus 16 +/- 4, p = 0.002) and presence of lymph node (38 +/- 8 vs. 20 +/- 8 months, p= 0.2) or liver metastases (51 +/- 9 vs. 21 +/- 6 months, p = 0.06). CONCLUSIONS Cytoreductive surgery combined with HIPEC is feasible and is associated with a reasonable morbidity and mortality. Complete cytoreduction may improve survival in select group of patients with low tumor volume and no organ metastases.