title: Minimally invasive secondary cytoreduction plus HIPEC for recurrent ovarian cancer: a case series.
abstract: OBJECTIVE
  To analyze the feasibility of laparoscopic/robotic secondary cytoreductive surgery and hyperthermic intraperitoneal intra-operative chemotherapy (SCS+HIPEC) in a retrospective series of isolated platinum sensitive recurrent ovarian cancer.
  
  
  METHODS
  We retrospectively evaluated a consecutive series of ovarian cancer patients with isolated platinum sensitive relapse. Isolated relapse was defined as the presence of a single nodule, in a single anatomic site. In all cases the presence of isolated relapse was assessed at pre-operative FDG-PET/CT scan, and confirmed with staging laparoscopy performed immediately before SCS+HIPEC.
  
  
  RESULTS
  84 women with platinum sensitive relapse received SCS+HIPEC during a 4-year period. Among them, 10 cases (11.9%) showed isolated relapse and were treated with laparoscopic/robotic SCS+HIPEC. In all cases complete debulking was achieved. In HIPEC treatment, 9 women received cisplatin at 75 mg/m(2), and the remaining patient oxaliplatin 460 mg/m(2). In 7 patients SCS was performed through the laparoscopic route, and in 3 cases with a robotic approach. The median operative time from skin incision to the end of cytoreductive surgery was 122 min (95-140), estimated blood loss was 50 cm(3) (50-100), and the median length of hospital stay was 4 days (3-7). The interval from surgery to adjuvant chemotherapy was 21 days (19-32). No grade 3/4 surgical, metabolic, or hematologic complications occurred. In all cases post-operative FDG-PET/CT scan was negative, and after a median time of 10 months (6-37) from SCS+HIPEC no secondary recurrence was observed.
  
  
  CONCLUSIONS
  Minimally invasive SCS+HIPEC can be safely performed in selected ovarian cancer patients with platinum sensitive isolated relapse.
authors.affiliation: Division of Minimally Invasive Gynaecological Surgery, St. Maria Hospital, University of Perugia, Terni, Italy. Electronic address: annafagotti@libero.it.
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Petrillo
authors.affiliation: Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Costantini
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Gallotta
authors.affiliation: Gynecologic Oncology Unit, Department of Oncology, Fondazione di Ricerca e Cura "Giovanni Paolo II", Catholic University of the Sacred Heart, Campobasso, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: L C
authors.initials: LC
authors.lastname: Turco
authors.affiliation: Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bottoni
authors.affiliation: Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D000077216:Carcinoma, Ovarian Epithelial; D002945:Cisplatin / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000077150:Oxaliplatin; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D009944:Organoplatinum Compounds; D019275:Radiopharmaceuticals; D000077150:Oxaliplatin; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin
keywords: HIPEC; Isolated platinum sensitive relapse; Laparoscopy; Minimally invasive surgery; Ovarian cancer; Robotic