title: Peritonectomy procedures and HIPEC in the treatment of peritoneal carcinomatosis from ovarian cancer: Long-term outcomes and perspectives from a high-volume center.
abstract: BACKGROUND
  Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) represents a radical therapeutic approach to achieve complete cytoreduction in ovarian peritoneal carcinomatosis. The aim of the present study was to analyze the outcomes obtained by the application of these procedures in a single center with extensive experience treating peritoneal carcinomatosis.
  
  
  METHODS
  A series of 218 consecutive patients diagnosed with peritoneal carcinomatosis from primary or recurrent ovarian cancer (FIGO stage IIIC-IV) and treated with CRS + HIPEC between January 1996 and June 2012 were included in this observational study.
  
  
  RESULTS
  Peritoneal carcinomatosis was treated primarily in 56% (124/218) of the cases and recurrently in 43% (94/218). A total of 42/218 patients (19%) presented with FIGO stage IV. Compared to recurrent cases, patients with primary ovarian carcinomatosis were older and presented higher Peritoneal Cancer Index (PCI) and percentage of FIGO stage IV; however, no significant differences in survival (5-year overall survival in patients with R0 cytoreduction, 63% and 56%, respectively) were observed. Cytoreduction score, PCI, lymphatic involvement and surgical morbidity ≥Grade III were statistically significant prognostic factors for survival in both univariate and multivariate analysis.
  
  
  CONCLUSIONS
  CRS + HIPEC treating macroscopic and microscopic disease is currently an excellent surgical approach to achieve high rates of complete cytoreduction and improve survival in patients with peritoneal carcinomatosis from ovarian cancer. In order to minimize the high potential morbidity of these procedures, CRS + HIPEC should be performed in highly experienced centers.
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain. Electronic address: fcocris@telefonica.net.
authors.forename: F C
authors.initials: FC
authors.lastname: Muñoz-Casares
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Medina-Fernández
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Arjona-Sánchez
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Casado-Adam
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Sánchez-Hidalgo
authors.affiliation: Department of Oncology, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rubio
authors.affiliation: Department of Pathology, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Ortega-Salas
authors.affiliation: Unit of Research, Maimonides Institute for Research in Biomedicine (IMIBIC), Córdoba, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Muñoz-Villanueva
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Rufián-Peña
authors.affiliation: Surgical Oncology Unit, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Briceño
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology*; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D017239:Paclitaxel; D002945:Cisplatin
keywords: Hyperthermic intraperitoneal chemotherapy; Ovarian cancer; Peritoneal carcinomatosis; Peritonectomy