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Heated IntraPEritoneal Chemotherapy (HIPEC) for Patients With Recurrent Ovarian Cancer: A Systematic Literature Review
  1. Alexander Hotouras, BSc, MSc, MBBS(Lon), MRCS(Eng), MD(Res),
  2. David Desai, BSc,
  3. Chetan Bhan, FRCS,
  4. Jamie Murphy, BChir, PhD, FRCS, (Gen Surg),
  5. Björn Lampe, MD and
  6. Paul H. Sugarbaker, MD, FACS, FRCS
  1. * Academic Surgical Unit, The Royal London Hospital, Whitechapel, UK;
  2. Department of Surgery, Whittington Hospital NHS Trust;
  3. University College London Hospital; and
  4. § Academic Surgical Unit, St Mary’s Hospital, Imperial College NHS Trust, London, UK;
  5. Kaiserswerther Diakonie, Florence Nightingale Hospital, Dusseldorf, Germany; and
  6. MedStar Washington Hospital Center, Washington, DC.
  1. Address correspondence and reprint requests to Alexander Hotouras, BSc, MSc, MBBS(Lon), MRCS(Eng), MD(Res), Academic Surgical Unit, Barts Health NHS Trust National Centre for Bowel Research and Surgical Innovation, Barts and the London School of Medicine and Dentistry, 2 Newark St, London E12AT, United Kingdom. E-mail: alex007{at}


Background Despite advances in surgical oncology, most patients with primary ovarian cancer develop a recurrence that is associated with a poor prognosis. The aim of this review was to establish the impact of Heated IntraPEritoneal Chemotherapy (HIPEC) in the overall survival of patients with recurrent ovarian cancer.

Methods A search of PubMed/MEDLINE databases was performed in February 2015 using the terms “recurrent ovarian cancer,” “cytoreductive surgery/cytoreduction,” and “heated/hyperthermic intraperitoneal chemotherapy.” Only English articles with available abstracts assessing the impact of HIPEC in patients with recurrent ovarian cancer were examined. The primary outcome measure was overall survival, whereas secondary outcomes included disease-free survival and HIPEC-related morbidity.

Results Sixteen studies with 1168 patients were analyzed. Most studies were Level IV, with 4 studies graded as Level III and 1 Level II. Cisplatin was the main chemotherapeutic agent used, but variations were observed in the actual technique, temperature of perfusate, and duration of treatment. In patients undergoing cytoreductive surgery and HIPEC, the overall survival ranged between 26.7 and 35 months, with disease-free survival varying between 8.5 and 48 months. Heated IntraPEritoneal Chemotherapy seems to confer survival benefits to patients with recurrent disease, with a randomized controlled study reporting that the overall survival is doubled when cytoreductive surgery is compared with cytoreductive surgery and chemotherapy (13. 4 vs 26.7 months). Heated IntraPEritoneal Chemotherapy–related morbidity ranged between 13.6% and 100%, but it was mainly minor and not significantly different from that experienced by patients who only underwent cytoreduction.

Conclusions Cytoreductive surgery and HIPEC seem to be associated with promising results in patients with recurrent ovarian cancer. Large international prospective studies are required to further quantify the true efficacy of HIPEC and identify the optimal treatment protocol for a maximum survival benefit.

  • Recurrent ovarian cancer
  • Heated IntraPEritoneal Chemotherapy

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  • The authors declare no conflicts of interest.