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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Carcinoma: Analysis of 30-Day Morbidity and Mortality

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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 30 days postoperatively were recorded.

Results

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 90 min, 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).

Conclusions

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.

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DISCLOSURE

James Cripe, Jill Tseng, Ramez Eskander, Amanda Nickles Fader, Edward Tanner, Robert Bristow have no financial or non-financial disclosures.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of California, Irvine Medical Center, Orange, CA, USA

    James Cripe MD, Ramez Eskander MD & Robert Bristow MD, MBA

  2. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA

    Jill Tseng MD, Amanda Nickles Fader MD & Edward Tanner MD

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  1. James Cripe MD
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  2. Jill Tseng MD
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  6. Robert Bristow MD, MBA
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Correspondence to James Cripe MD.

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Cripe, J., Tseng, J., Eskander, R. et al. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Carcinoma: Analysis of 30-Day Morbidity and Mortality. Ann Surg Oncol 22, 655–661 (2015). https://doi.org/10.1245/s10434-014-4026-6

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  • DOI: https://doi.org/10.1245/s10434-014-4026-6

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