Objectives The risk of morbidity and mortality associated with CRS & HIPEC is substantial enough to make any surgeon think twice before adopting it. Knowing the factors that will predict morbidity would help us optimize outcomes & improve care. This study is an attempt to find such factors that predict morbidity.

Methods Patients diagnosed of peritoneal carcinomatosis from epithelial ovarian malignancy underwent CRS+ HIPEC from March 2012 to December 2017. All data prospectively entered in the HIPEC registry was analysed with main focus on morbidity and factors predicting morbidity .

Results Out of 110 patients, 20, 55,35 underwent upfront, interval & secondary CRS+HIPEC respectively. Mean duration of surgery was 9.5 hours, blood loss 1250 mL & PCI 17. Total, upper & pelvic peritonectomy with glissons capsulectomy & mesenteric stripping was done in 42.5%, 68.1%, 69.3%, 14.7% & 4.3%respectively. Multivisceral , diaphragmatic & bowel resections were done in 20.9%, 40.5% & 57.5% respectively. G3-G5 morbidity was noted in 40%, major being surgical 30%, hematological 20%, electrolyte imbalances 19%. Performance status, mean PCI >14, duration of surgery >10 hours, multivisceral resections, upper quadrant peritonectomy & more than one anastomosis were found to be significant factors predicting morbidity on univariate analysis. On multivariate analysis performance status & upper quadrantectomy were significant factors.

Conclusions CRS + HIPEC for advanced epithelial ovarian malignancy can be done with acceptable morbidity & mortality. A dedicated team is a absolute necessity. We should be more cautious & give extra attention to patients with above mentioned risk factors to improve the quality of care & optimize outcomes with CRS+ HIPEC.