Introduction Bowel anastomosis before or after HIPEC has been an unresolved debate. We report our experience of impact of HIPEC on anastomosis performed before or after.

Methods Patients diagnosed with advanced epithelial ovarian cancer undergoing CRS+ HIPEC who had bowel resection & anastomoses performed were included in the study. Our institution has two teams, of which one performs anastomosis before and one after HIPEC. Uni-variate and multivariate analysis performed to find factors predicting bowel complications.

Results 135 of 220 patients had bowel resection & restoration as a part of CRS+ HIPEC for advanced epithelial ovarian cancer. Of 135 patients, 66 had anastomosis before HIPEC and 69 after HIPEC. Mean PCI 13.4±4.5, blood loss 850±302.9 ml, duration of surgery 9.5±2.4 hr. Overall 57.05% had bowel resections, of which large bowel was 75.8% & small bowel 24.2% & stoma rate was 6.4%. Both the group had same number of total (55.4%vs58.6%), small (15.3%vs16.5%) & large bowel resections (44.3%vs 49.5%). We had 4 (2.9%) leak overall, of which 2 were in either groups. Prior surgical score, recurrent ovarian cancers, number of anastomosis >2, duration of surgery >8.5 hrs were significant on uni-variate analysis. On multivariate analysis prior surgical score >1 was significant.

Conclusions We conclude that leak rates & complications related to small or large bowel anastamosis is same when anastamosis is done either before or after HIPEC. However, since this is not a randomized study a well-designed multi-institutional randomized study needs to be planned for stronger evidence of the same.