Perioperative outcomes in patients treated with total parietal peritonectomy and multi-visceral resections with or without HIPEC at different time points in the history of advanced ovarian cancer

Objective: The morbidity of hyperthermic intraperitoneal chemotherapy (HIPEC) in relation to the extent of surgical resection has not been analyzed in advanced ovarian cancer. The goal was to evaluate the perioperative outcomes in patients treated with a total parietal peritonectomy (TPP) and multi-visceral resections with/without HIPEC at different time points in the history of advanced ovarian cancer. Methods: This is a retrospective study of 144 patients treated from 1 December 2018 to 30 June 2020. In the interval setting, a TPP was performed as part of a registered protocol (CTRI 2018/12/016789) and in the primary and recurrent setting when the extent of disease necessitated it. The analysis of the perioperative outcomes included evaluation of the 90-day grade 3–4 morbidity and mortality and time to starting adjuvant chemotherapy. Results: Thirty (20.8%) patients had primary cytoreductive surgyer (CRS), 90 (62.5%) interval CRS and 24 (16.2%) CRS for recurrence. HIPEC was performed in 57 (39.5%) patients. 93.7% had all 7 peritonectomies, 61% had more than three visceral resections and 62.5% had at least one bowel anastomosis. Grade 3–4 morbidity was seen in 31.9% and was similar with/without HIPEC. On multi-variable logistic regression analysis, patients receiving neoadjuvant chemotherapy (p = 0.031) and undergoing small bowel resection (p = 0.038) had a higher risk of grade 3–4 morbidity and those with peritoneal cancer index (PCI) $<$10 (p = 0.001) had a lower risk. All except two patients started chemotherapy within 6 weeks of surgery. Conclusions: In this study, the addition of HIPEC to TPP and multi-visceral resections had an acceptable morbidity. The morbidity was affected by the disease extent and the extent of surgery performed and not by HIPEC.

Advanced ovarian cancer; Cytoreductive surgery; HIPEC; Total parietal peritonec-tomy; Major-morbidity; Post-operative morbidity

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