Objectives The avaliability of new devices aimed at improving fluid distribution with a CO2 Peritoneal Recirculation System (PRS-1.0 Combat) may be useful to further improve the clinical benefit recently showed by hypertermic intraperitoneal chemotherapy (HIPEC) after interval debulking surgery (IDS) in advanced ovarian cancer (AOC) patients. This study aimed at assessing the feasibility and perioperative outcomes of the CO2 PRS HIPEC after IDS.

Methods Over the study period 24 patients were prospectively enrolled. Patients underwent 3 neoadjuvant cycles of carboplatin AUC5 + paclitaxel 175 mg/m2 and IDS with absent residual disease. Sodium thiosulfate (9 g/m2) was administered before CO2 PRS HIPEC with cisplatin (75 mg/m2, temperature 42°C, for 60 minutes).

Results Almost one third of patients (37,5%) underwent ultraradical surgery with 12.5% bowel resections. Median blood loss was 500 (100–1200) mL and mean operative time 407.5 minutes. Median (range) intensive care unit stay and time-to-discharge were 0 (0–10) and 6 (4–17) days, respectively. We registered 3/24 (12.5%) early serious adverse events including one acute respiratory failure and two acute kidney injuries (only one of these retained a mild chronic renal failure); one patient was readmitted within 30 days after discharge because of a dehiscence of the vaginal vault. No late adverse events were reported. Median time-to-chemotherapy was 33 days (range 22- 51).

Conclusions The CO2 PRS may improve the safety profile of HIPEC in the setting of IDS for AOC patients probably because of the more tailored drug distribution.