Article Text
Abstract
Introduction Epithelial ovarian cancer (EOC) is challenging in terms of diagnosis and treatment. Although HIPEC showed an increase in overall survival (OS) and event-free survival (EFS), its application remains unguided. This meta-analysis compares patients with advanced primary and recurrent EOC undergoing cytoreductive surgery (CRS) and HIPEC versus CRS alone and is registered in PROSPERO with the number CRD42018102289 with registry name of Professor David Atallah.
Methods We searched clinicaltrials.gov, Embase, Cochrane, PubMed, Scopus, Google scholar, Web of science and Grey literature without restriction on time for an extensive analysis, investigating OS, EFS and complications, in HIPEC and CRS versus CRS-alone, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines
Results We included 2251 patients from 18 studies evaluating OS. Among these, 13 studies assessed EFS. HIPEC significantly improved OS (HR = 0.65, 95% CI: 0.5 to 0.85) and EFS (HR = 0.71, 95% CI: 0.58 to 0.87). Specifically, patients with primary EOC undergoing interval debulking surgery (IDS) with HIPEC, had upswing of OS and EFS. The open technique exhibited optimum outcomes. Studies including paclitaxel-only regimens achieved amelioration, while combination with doxorubicin had worse outcomes. The incidence of grade III-IV complications is higher in HIPEC groups, compared to CRS-only groups with a pooled RR 1.229 (95% Cl: 1.057-1.43).
Conclusion/Implications The incorporation of HIPEC in IDS improved OS and EFS in primary EOC while the incidence of complications are higher in HIPEC groups compared to CRS groups. Therefore, the efficacy of HIPEC during CRS in the management of EOC should be further investigated.