Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer

The aim of this systematic review is to critically evaluate cytoreductive surgery combined with heated intraoperative intraperitoneal chemotherapy in the treatment of ovarian cancer. A systematic review of all manuscripts published in the English literature that met predetermined inclusion criteria was carried out. Data concerning cytoreductive surgery, method and agents for administration of heated intraoperative intraperitoneal chemotherapy, morbidity, mortality, hospital stay and survival were extracted, critically reviewed and tabulated. Fourteen studies were analyzed. A wide variety of drug doses, methods of intraperitoneal chemotherapy administration and volume of chemotherapy solution were used. Seven studies showed that patients with complete cytoreduction had the greatest benefit. The median overall survival for primary and recurrent disease ranged from 22 to 54 months and the median disease-free survival from 10 to 26 months. The rates of significant morbidity associated with this combined treatment were low, ranging from 5% to 36%. The median mortality was 3% (range 0%-10%). Cytoreductive surgery combined with heated intraoperative intraperitoneal chemotherapy is a treatment option for patients with ovarian cancer that is worthy of further investigation. Selection criteria for patients most likely to benefit need to be defined.