Advances in Gynecological Onco surgery.”CRS and HIPEC: The New Hope in Ovary Cancer”

Ovarian cancer is one of the deadliest gynecological 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 gynecological 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 outcomes recently being at their worst. With a recent better understanding of the nature of disease, it is no longer considered a disease limited to the pelvis; rather, it is a disease that is confined to the abdominal cavity in most cases. Even when it presents as recurrences, it is mostly in the form of peritoneal surfaces of the abdominopelvic cavity.

New therapeutic approaches aiming to prevent peritoneal recurrence are being evaluated. One of these approaches consists 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 the concept of debulking), with hyperthermic intraperitoneal chemotherapy (HIPEC), which is presumed to induce higher clearance of microscopic peritoneal lesions than with intravenous chemotherapy.

Recent studies have shown improvements in both overall survival and disease-free survival with this novel therapy. In our own experience of more than 150 such cytoreductive procedures, we have found this modality to be effective with improved outcomes and acceptable morbidity and mortality. Even in recurrent settings, in properly selected patients, this aggressive form of surgical treatment has been shown to give better results than conventional treatment.

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