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Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods
  1. Beatriz Navarro Santana1,
  2. Esmeralda Garcia-Torralba2,
  3. David Viveros-Carreño3,4,
  4. Juliana Rodriguez5,
  5. Rene Pareja3,
  6. Alicia Martin6,
  7. Sara Forte7,
  8. Kate J Krause8,
  9. J M González-Martín6 and
  10. Pedro T Ramirez9
  1. 1University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
  2. 2Hospital Morales Meseguer, Murcia, Spain
  3. 3Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
  4. 4Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo-CTIC, Bogotá, Colombia
  5. 5Instituto Nacional de Cancerologia, Bogota, Colombia
  6. 6Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
  7. 7Azienda USL Toscana centro, Prato, Italy
  8. 8The University of Texas MD Anderson Cancer Center Research Medical Library, Houston, Texas, USA
  9. 9Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Beatriz Navarro Santana, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain; bea_0904{at}


Objective Cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review was to assess the rate of complications associated with HIPEC in epithelial ovarian cancer surgery over two time periods.

Methods This study was registered in PROSPERO (CRD42022328928). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Ovid/Medline, Ovid/Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 2004 to April 2022. We included studies reporting on patients with advanced primary or recurrent epithelial ovarian cancer who underwent cytoreductive surgery and HIPEC. We evaluated two different time periods: 2004–2013 and 2014–2022. A random-effects meta-analysis was used to produce an overall summary. Subgroup analyses were planned according to recruited period for each specific complication type. Heterogeneity was assessed using the I2 statistic.

Results A total of 4928 patients were included from 69 studies for this systematic review; 19 published from 2004–2013, and 50 published from 2014–2022. No significant differences were found between the two time periods in terms of blood transfusions (33% vs 51%; p=0.46; I2=95%) overall gastrointestinal complications (15% vs 21%; p=0.36; I2=98%), infectious diseases (16% vs 13%; p=0.62; I2=93%), overall respiratory complications (12% vs 12%; p=0.88; I2=91%), overall urinary complications (6% vs 12%; p=0.06; I2=94%), or thromboembolic events (5% vs 3%; p=0.25; I2=63%). Also, no differences were found in intensive care unit (ICU) admissions (89% vs 28%; p=0.06; I2=99%), reoperations (8% vs 7%; p=0.50; I2=37%), or deaths (3% vs 3%; p=0.77; I2=57%).

Conclusions Our review showed that overall complications have not changed over time for patients undergoing HIPEC in the setting of primary or recurrent ovarian cancer. There was no decrease in the rates of ICU admissions, reoperations, or deaths.

  • ovarian neoplasms
  • postoperative complications

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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  • Twitter @julianalrc, @RParejaGineOnco, @pedroramirezMD

  • Contributors BNS: Conceptualization, methodology, formal analysis, investigation, writing- original draft, visualization. EG-T: Methodology, Formal analysis, validation, writing- original draft; DV-C: Methodology, investigation, writing- original draft, Writing - Review and Editing; JR: Investigation, Methodology, Resources, Writing - Review and Editing; RP: Resources, Writing - Review and Editing; SF: Investigation, writing- original draft; KJK: Methodology. AM: Investigation, Writing - Review and Editing; JMG-M: Methodology, Formal analysis; PTR: Term, conceptualization,Writing - Review and Editing. Supervising, validation, guarantor

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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