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Evaluation of Extensive Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients With Advanced Epithelial Ovarian Cancer
  1. Luca Ansaloni, MD*,
  2. Vanni Agnoletti, MD,
  3. Andrea Amadori, MD,
  4. Fausto Catena, MD§,
  5. Davide Cavaliere, MD,
  6. Federico Coccolini, MD*,
  7. Pierandrea De Iaco, MD,
  8. Monica Di Battista, MD#,
  9. Massimo Framarini, MD,
  10. Filippo Gazzotti, MD§,
  11. Claudio Ghermandi, MD**,
  12. Barbara Kopf, MD††,
  13. Maristella Saponara, MD#,
  14. Francesca Tauceri, MD,
  15. Carlo Vallicelli, MD§,
  16. Giorgio Maria Verdecchia, MD and
  17. Antonio Daniele Pinna, MD§
  1. *Unit of General Surgery I, Ospedali Riuniti of Bergamo, Bergamo, Italy;
  2. Unit of Anaesthesiology, and
  3. Unit of Gynecology and Obstetrics, Morgagni-Pierantoni Hospital, Forlì, Italy;
  4. §Unit of General, Emergency and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy;
  5. Unit of Surgery and Advanced Oncologic Therapies, Morgagni-Pierantoni Hospital, Forlì, Italy;
  6. Unit of Gynaecology and Obstetrics,
  7. #Unit of Medical Oncology, and
  8. **Unit of Anaesthesiology, St. Orsola-Malpighi University Hospital, Bologna, Italy; and
  9. ††Unit of Medical Oncology, Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori (IRST), Forlì, Italy.
  1. Address correspondence and reprint requests to Luca Ansaloni, MD, Ospedali Riuniti di Bergamo, largo Barozzi 1, 24128 Bergamo, Italy. E-mail:


Objective Although standard treatment for advanced epithelial ovarian cancer (EOC) consists of surgical debulking and intravenous platinum- and taxane-based chemotherapy, favorable oncological outcomes have been recently reported with the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of the study was to analyze feasibility and results of CRS and HIPEC in patients with advanced EOC.

Materials/Methods This is an open, prospective phase 2 study including patients with primary or recurrent peritoneal carcinomatosis due to EOC. Thirty-nine patients with a mean (SD) age of 57.3 (9.7) years (range, 34–74 years) were included between September 2005 and December 2009. Thirty patients (77%) had recurrent EOC and 9 (23%) had primary EOC.

Results For HIPEC, cisplatin and paclitaxel were used for 11 patients (28%), cisplatin and doxorubicin for 26 patients (66%), paclitaxel and doxorubicin for 1 patient (3%), and doxorubicin alone for 1 patient (3%). The median intra-abdominal outflow temperature was 41.5°C. The mean peritoneal cancer index (PCI) was 11.1 (range, 1–28); and according to the intraoperative tumor extent, the tumor volume was classified as low (PCI <15) or high (PCI ≥15) in 27 patients (69%) and 12 patients (31%), respectively. Microscopically complete cytoreduction was achieved for 35 patients (90%), macroscopic cytoreduction was achieved for 3 patients (7%), and a gross tumor debulking was performed for 1 patient (3%). Mean hospital stay was 23.8 days. Postoperative complications occurred in 7 patients (18%), and reoperations in 3 patients (8%). There was one postoperative death. Recurrence was seen in 23 patients (59%) with a mean recurrence time of 14.4 months (range, 1–49 months).

Conclusions Hyperthermic intraperitoneal chemotherapy after extensive CRS for advanced EOC is feasible with acceptable morbidity and mortality. Complete cytoreduction may improve survival in highly selected patients. Additional follow-up and further studies are needed to determine the effects of HIPEC on survival.

  • Peritoneal carcinomatosis
  • Ovarian cancer
  • Cytoreductive surgery
  • Intraperitoneal chemotherapy

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  • The research and its publication were entirely funded by the Department of Surgery, St. Orsola-Malpighi, University Hospital of Bologna (Italy) and the Unit of Surgery and Advanced Oncologic Therapies, Morgagni-Pierantoni Hospital, Forlì (Italy).

  • The authors declare that there are no conflicts of interest.