Objectives The addition of HIPEC to IDS in AOC has recently showed advantages in prolonging both disease-free and overall survival in AOC patients responding to neoadjuvant chemotherapy. We investigated the pattern of recurrence in a preliminary series of AOC patients treated by HIPEC with a new CO2 PRS after IDS.

Methods Twenty patients were prospectively enrolled during the study period. All patients underwent 3 cycles of neoadjuvant chemotherapy with carboplatin AUC5 + paclitaxel 175 mg/m2 and achieved complete cytoreduction at the time of IDS. HIPEC with cisplatin (75 mg/m2, temperature 42°C, for 60 minutes) was administered with a closed CO2 PRS.

Results Seven out of twenty (35%) patients underwent ultraradical surgical procedures and 3 (15%) bowel resection. After a median follow-up of 21 months (range 7–28) we registered 9 recurrences with a median time-to-recurrence of 9 months (range 5–21). Interestingly 7/9 (77.8%) recurrences were nodal while only one patient had peritoneal relapse (5%) and one more recurred with pleural disease. Only 2 patients died from relapsed disease.

Conclusions Our preliminary efficacy data showed that peritoneal recurrence in AOC may be potentially reduced by the implementation of HIPEC with the CO2 PRS, probably due to a better drug distribution in the peritoneal cavity. This is of critical importance given that pattern of recurrence as carcinomatosis is undoubdtely associated with unfavourable outcome.