Indian Journal of Surgical Oncology

, Volume 10, Supplement 1, pp 57–64 | Cite as

Impact of Radicality Versus Timing of Surgery in Patients with Advanced Ovarian Cancer (Stage III C) Undergoing CRS and HIPEC—a Retrospective Study by INDEPSO

  • Aditi BhattEmail author
  • Snita Sinukumar
  • Firoz Rajan
  • Dileep Damodaran
  • Mukurdipi Ray
  • Shabber Zaveri
  • Praveen Kammar
  • Sanket Mehta
Original Article


HIPEC in addition to interval CRS has shown a survival benefit of 12 months compared to CRS alone. However, there are many controversial issues pertaining to CRS itself which should be addressed first. To compare NACT and primary CRS approaches when CRS is categorized according to the extent of resection. To evaluate the feasibility of performing HIPEC at these two time points. A retrospective analysis of patients with stage III C ovarian cancer undergoing primary and interval CRS + HIPEC was performed. The surgical approach for interval CRS was classified as (1) resection of sites of residual disease alone or (2) resection of sites involved before NACT. The morphological response was divided into different categories, and surgeons had to state what they consider residual disease and what they do not. From January 2013 to December 2017, 54 patients were included (18-primary; 36-interval). Median PCI 11 vs 6.5 (p = 0.07); CC-0 was obtained in 77.7%. Three surgeons resected previously involved sites; three sites of residual disease only. All surgeons resected areas of scarring. Twenty percent patients had residual disease in “normal-looking” peritoneum. Morbidity (p = 0.09), median OS (p = 0.71), and median DFS (p = 0.54) were similar in the two groups. Early recurrence occurred in 50% with resection of residual disease alone compared to 16.6% when previous disease sites were resected (p = 0.07). Interval CRS should be performed to resect sites involved prior to NACT and not just sites of residual disease. HIPEC can be performed in both primary/interval settings with acceptable morbidity.


Ovarian cancer Cytoreductive surgery Interval debulking HIPEC Radical surgery Interval CRS 


Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyZydus HospitalAhmedabadIndia
  2. 2.Department of Surgical OncologyJehangir hospitalPuneIndia
  3. 3.Department of Surgical OncologyKovai Medical centerCoimbatoreIndia
  4. 4.Department of Surgical OncologyMVR Cancer Centre and Research InstituteCalicutIndia
  5. 5.Department of Surgical OncologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
  6. 6.Department of Surgical OncologyManipal HospitalsBangaloreIndia
  7. 7.Department of Surgical OncologySaifee HospitalMumbaiIndia

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