HIPEC after Interval Debulking Surgery as Best Clinical Practice in Ovarian Cancer Patients: Case Series and Literature Review

Abstract

HIPEC after Interval Debulking Surgery as Best Clinical Practice in Ovarian Cancer Patients: Case Series and Literature Review Stefano Restaino1 , Jessica Mauro1,2 , Stefano Cianci3,*, Alessandro Buda4 , Claudia Andreetta5 , Elena Poletto5 , Enrico Maria Pasqual6 , Alice Poli1,2 , Cosimo Vittorio Agrimi7 , Doriana Armenise7 , Alice Buzzelli7 , Domenico Caccamo7 , Lorenza Driul1,2 , Giuseppe Vizzielli1,2 1Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia”, University Hospital - Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy 2Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy 3Department of Human Pathology of Adult and Childhood “G. Barresi”, Unit of Gynecology and Obstetrics, University of Messina, 98122 Messina, Italy 4Division of Gynecologic Oncology, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy 5Department of Oncology, ASUFC Udine University Hospital, 33100 Udine, Italy 6Department of Medical Area, University of Udine, Santa Maria della Misericordia University Hospital Udine, 33100 Udine, Italy 7University of Udine, Department of Medical Area (DAME), Medical School, 33100 Udine, Italy *Correspondence: stefanoc85@hotmail.it (Stefano Cianci) Academic Editor: Samir A. Farghaly Submitted: 17 February 2022 Revised: 15 April 2022 Accepted: 26 April 2022 Published: 16 June 2022 Abstract Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with interval debulking surgery (IDS) constitutes an adjunctive treatment strategy in advanced ovarian cancer (AOC). This approach is based on the concept of perfusing chemotherapy targeting directly the site of residual tumor after optimal surgical debulking. It improves patients’ outcome in terms of overall survival (OS) and disease free survival (DFS). The correct selection of patients eligible for IDS + HIPEC is crucial: in particular, they must have shown a good response to neoadjuvant chemotherapy (NACT) and have a good performance status (PS). The application of HIPEC at the end of debulking does not seem to increase neither the rate of intra/postoperative complications nor the time of hospitalization. Clinical Cases: After approving an internal protocol for the application of HIPEC in our hospital, we have submitted four patients to IDS + HIPEC in the past 12 months. One of these patients underwent a minimally invasive procedure. No intra- or postoperative complications were observed. Results: All patients underwent IDS + HIPEC after being assessed as eligible and after showing a good response to NACT. In the course of IDS in all cases complete debulking was achieved. No patient developed intra- or postoperative complications. Conclusions: The addition of HIPEC to interval debulking surgery should be offered to all eligible patients, considering that the association of HIPEC to IDS seems to improve patients’ outcomes in terms of OS and DFS, without increasing post-operative morbidity . Keywords: advanced ovarian cancer; HIPEC; interval debulking surgery