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Review
. 2022 Dec 6;14(23):6010.
doi: 10.3390/cancers14236010.

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

Daniele Marrelli  1 , Luca Ansaloni  2 , Orietta Federici  3 , Salvatore Asero  4 , Ludovico Carbone  1 , Luigi Marano  1 , Gianluca Baiocchi  5 , Marco Vaira  6 , Federico Coccolini  7 , Andrea Di Giorgio  8 , Massimo Framarini  9 , Roberta Gelmini  10 , Carmen Palopoli  11 , Fabio Accarpio  12 , Anna Fagotti  13
Affiliations
Review

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

Daniele Marrelli et al. Cancers (Basel). .

Abstract

Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient's perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.

Keywords: advanced ovarian cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; neoadjuvant chemotherapy; peritoneal metastases.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Pelvic peritonectomy with en-bloc 7ysteron-adnexectomy. Dotted line represents the standard peritoneal resection margin after neoadjuvant chemotherapy with downstaging of peritoneal metastases; in most cases, no bowel resection is necessary to obtain a CCR-0 pelvic cytoreduction. Reproduced from Sugarbaker P. H. (2013). Adapted with permission from AME Publishing Company (accessed on 6 May 2022). (b) Pelvic peritoneum removed en-bloc with uterus and adnexa. Note the “bat shape” aspect of the resected specimen [128].
Figure 2
Figure 2
Female patient with peritoneal metastases from ovarian cancer: (a) CT of the abdomen showing a nodule of peritoneal metastases in right subphrenic region. (b) Laparoscopic PCI assessment confirming the imaging findings. (c) Completed right subphrenic peritonectomy.
Figure 3
Figure 3
Completed mesenteric peritonectomy of the small bowel.
Figure 4
Figure 4
Italian PSM Oncoteam evidence. (a) Cavaliere et al. “1st Evidence−based Italian consensus conference on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis from ovarian cancer”. This image is licensed under the STM Guidelines http://www.stm-assoc.org/copyright-legal-affairs/permissions/permissions-guidelines/ (accessed on 16 May 2022). Reproduced with permission from Cavaliere D. (2017). (b) Di Giorgio et al. “Cytoreduction (Peritonectomy Procedures) Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Advanced Ovarian Cancer: Retrospective Italian Multicenter Observational Study of 511 Cases”. This image is licensed under the Creative Commons Attribution http://creativecommons.org/licenses/by/4.0 (accessed on 16 May 2022). Reproduced with permission from Di Giorgio A. (2016). (c) Biacchi et al. “Upfront debulking surgery versus interval debulking surgery for advanced tubo-ovarian high-grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC”. VLS: videolaparoscopy, ChT: chemotherapy, neoCht: neoadjuvant chemotherapy, PCI: peritoneal cancer index, CC: complete cytoreduction, FIGO: International Federation of Gynecology and Obstetrics, OS: overall survival, PFS: progression-free survival, CRS: cytoreductive surgery, HIPEC: hyperthermic intraperitoneal chemotherapy.
Figure 4
Figure 4
Italian PSM Oncoteam evidence. (a) Cavaliere et al. “1st Evidence−based Italian consensus conference on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis from ovarian cancer”. This image is licensed under the STM Guidelines http://www.stm-assoc.org/copyright-legal-affairs/permissions/permissions-guidelines/ (accessed on 16 May 2022). Reproduced with permission from Cavaliere D. (2017). (b) Di Giorgio et al. “Cytoreduction (Peritonectomy Procedures) Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Advanced Ovarian Cancer: Retrospective Italian Multicenter Observational Study of 511 Cases”. This image is licensed under the Creative Commons Attribution http://creativecommons.org/licenses/by/4.0 (accessed on 16 May 2022). Reproduced with permission from Di Giorgio A. (2016). (c) Biacchi et al. “Upfront debulking surgery versus interval debulking surgery for advanced tubo-ovarian high-grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC”. VLS: videolaparoscopy, ChT: chemotherapy, neoCht: neoadjuvant chemotherapy, PCI: peritoneal cancer index, CC: complete cytoreduction, FIGO: International Federation of Gynecology and Obstetrics, OS: overall survival, PFS: progression-free survival, CRS: cytoreductive surgery, HIPEC: hyperthermic intraperitoneal chemotherapy.
Figure 5
Figure 5
Italian PSM Oncoteam study purposes. (a) Marrelli et al. “OVANAC–HIPEC”. (b) Ansaloni et al. “CHORINE”. FIGO: International Federation of Gynecology and Obstetrics, neoadj: neoadjuvant therapy, CRS: cytoreductive surgery, HIPEC: hyperthermic intraperitoneal chemotherapy.
See this image and copyright information in PMC

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