Advances In Gynaecological Onco surgery.” CRS & HIPEC The New Hope In Ovary Cancer”

Ovarian cancer is one of the deadliest gynaecological malignancies and tends to be diagnosed at an advanced stage, with almost three fourths of cases at the time of diagnosis being stage III C or more. Its incidence is increasing globally. It is the third most common gynaecological cancer in Indian women with more than sixty thousand cases being diagnosed every year.

Historically the treatment for Ovarian cancer consisted of debulking surgery ( Hysterectomy with oophorectomy and infracolic omentectomy) and chemotherapy with survival outcome till recently being at the best dismal. With recent better understanding of the nature of disease it is no longer considered a disease limited to pelvis , rather it is a disease that is confined to the abdominal cavity in most of the cases .Even when it presents as recurrences mostly it is in the form of peritoneal surfaces of abdominopelvic cavity.

New therapeutic approaches aiming to prevent peritoneal recurrence are being evaluated. One of these approaches consist of associating a complete cytoreduction removing the entirety of macroscopic lesions (including extensive peritonectomy and visceral resections if required so as to ensure no visible macroscopic disease at the end of surgery contrary to concept of debulking) with hyperthermic intraperitoneal chemotherapy (HIPEC) that is presumed to induce higher clearance of microscopic peritoneal lesions than with intravenous chemotherapy.

Recent studies have shown improvement in both Overall survival as well as Disease free survival with this novel therapy. In our own experience of more than 150 such cytoreductive procedure we have found this modality to be effective with improved outcomes and with acceptable morbidity and mortality. Even in recurrent settings in properly selected patients this aggressive form of surgical treatment has shown to give better results than the conventional treatment.

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