Minimally Invasive Secondary Cytoreduction Plus HIPEC Versus Open Surgery Plus HIPEC in Isolated Relapse From Ovarian Cancer: A Retrospective Cohort Study on Perioperative Outcomes

Study Objective: To compare the perioperative outcomes of minimally invasive secondary cytoreduction surgery (SCS) plus hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) versus open surgery plus HIPEC in a group of platinum-sensitive patients with advanced epithelial ovarian cancer (AEOC) with isolated relapse. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. Patients: We selected 22 patients with a peritoneal cancer index value of 2. The laparoscopic group consisted of 11 patients who underwent laparoscopic and/or robotic complete cytoreduction plus HIPEC, whereas the laparotomic group consisted of 11 patients who underwent complete laparotomic cytoreduction plus HIPEC. Interventions: The minimally invasive surgery (MIS) group were platinum-sensitive single recurrent ovarian cancer patients who underwent either laparoscopic or robotic complete secondary cytoreduction plus HIPEC, whereas the open group were women with similar clinical characteristics who underwent complete secondary cytoreduction plus HIPEC by laparotomy. Measurements and Main Results: The median operative time, calculated from the skin incision to the end of SCS (i.e., excluding HIPEC phase) was 125min (range 95-150min) in the MIS group and 295min (range 180-420) in the open group (p=001), with a median estimated blood loss of 50mL (range 50-100) and 500mL (range 50-1300), respectively (p=025). The median length of hospital stay was 4days (range 3-17) in the MIS group and 8.5days (range 4-30) in the open group (p=002). No statistically significant differences were registered in terms of intra- and postoperative complications between the 2 groups. Conclusion: The minimally invasive approach for SCS plus HIPEC is safe and efficient in terms of toxicity and postoperative outcomes for single isolated relapse. HIPEC should not be considered a major contraindication to a minimally invasive approach.