Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of stage III–IV primary ovarian cancer


  • Ya.S. Nazarov Bogomolets National Medical University, Kyiv, Ukraine,
  • V.I. Kopetskyi National Cancer Institute, Kyiv, Ukraine,
  • Ye.A. Shudrak National Cancer Institute, Kyiv, Ukraine,



ovarian cancer, stage III–IV ovarian cancer, cytoreductive surgery, debulking, hyperthermic intraperitoneal chemotherapy, review


Ovarian cancer (OC) is the most aggressive female genital cancer, which is characterized by implant growth, visceral and parietal peritoneal carcinomatosis and damage to the abdominal cavity and retroperitoneal space. Every year, more than 290,000 new cases of OC and 180,000 deaths from this pathology are registered worldwide. Stage III–IV OC is a primary diagnosis in 80 % of the patients. Classic procedures like radical hysterectomy and omentectomy are not sufficient for the recovery of such patients. Additional interventions in pelvic, extrapelvic and upper abdomen organs might be required. Such procedures demand high-skill surgeon techniques. Primary complete cytoreduction which imply complete removal of all masses followed by the adjuvant chemotherapy is the gold standard in the treatment for stage III–IV OC. Hyperthermic intraperitoneal chemotherapy is the novel option in the treatment of OC, which could increase overall and disease-free survival rate in these patients.


Global Cancer Observatory: Ovarian cancer. [Internet]. Lyon. Fr. Int. Agency Res. Cancer. 2018 [cited 2019 Jun 6]; available from: https: //

Torre L.A., Bray F., Siegel R.L. et al. Global cancer statistics, 2012. CA Cancer J. Clin. 2015. 65 (2). 87-108. doi: 10.3322/caac.21262.

Torre L.A., Siegel R.L., Ward E.M. et al. Global cancer incidence and mortality rates and trends — an update. Cancer Epidemiol. Biomar­kers Prev. 2016. 25 (1). 16-27. doi: 10.1158/1055-9965.EPI-15-0578.

Kurman R., Carcangiu M., Herrington C. WHO Classification of tumours of female reproductive organs. Lyon: IARC Press, 2014.

Amin M., Greene F., Edge S. AJCC Staging Manual, 8th edition: Springer International Publishing. 2017. 1-1024.

Hennessy B.T., Coleman R.L., Markman M. Ovarian cancer. Lancet. 2009 Oct 17. 374 (9698). 1371-82. doi: 10.1016/S0140-6736 (09)61338-6.

Chan D.L., Morris D.L., Rao A., Chua T.C. Intraperitoneal chemotherapy in ovarian cancer: a review of tolerance and efficacy. Cancer Manag. Res. 2012. 4. 413-22. doi: 10.2147/CMAR.S31070.

Eisenkop S.M., Spirtos N.M. What Are the Current Surgical Objectives, Strategies, and Technical Capabilities of Gynecologic Oncologists Treating Advanced Epithelial Ovarian Cancer? Gynecol. Oncol. 2001 Sep. 82 (3). 489-97. doi: 10.1006/gyno.2001.6312.

Sugarbaker P.H. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of advanced primary and recurrent ovarian cancer. Curr. Opin. Obstet. Gynecol. 2009 Feb. 21 (1). 15-24. doi: 10.1097/GCO.0b013e32831f8f32.

Sugarbaker P.H. Peritonectomy procedures. Ann. Surg. 1995. 221. 29-42. doi: 10.1097/00000658-199501000-00004.

National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Ovarian cancer. Version 1.2020; available from: https. //

European Society of Gynaecological Oncology (ESGO) Guidelines for Ovarian Cancer Surgery. Version 2.2017; available from: http: //

Bogani G., Ditto A., Martinelli F., Lorusso D. et al. Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis. Int. J. Gynecol. Cancer. 2016. 26 (2). 371-80. doi: 10.1186/s12885-017-3311-8.

Chang S.J., Bristow R.E. Surgical technique of en bloc pelvic resection for advanced ovarian cancer. J. Gynecol. Oncol. 2015. 26. 155. doi: 10.3802/jgo.2015.26.2.155.

Houvenaeghel G., Gutowski M., Buttarelli M., Cuisenier J., Narducci F., Dalle C. et al. Modified posterior pelvic exenteration for ovarian cancer. Int. J. Gynecol. Cancer. 2009. 19. 968-73. doi: 10.1111/IGC.0b013e3181a7f38b.

Jones N.L., Chen L., Chatterjee S., Tergas A.I. et al. National trends in extended procedures for ovarian cancer debulking surgery. Int. J. Gynecol. Cancer. 2018 Jan. 28 (1). 19-25. doi: 10.1097/IGC.0000000000001132.

Son J.H. et al. Perioperative outcomes of extensive bowel resection during cytoreductive surgery in patients with advanced ovarian cancer. J. Surg. Oncol. 2019. Jun. 119 (7). 1011-1015. doi: 10.1002/jso.25403.

Oseledchyk A., Abramian A., Kaiser C. et al. Total or subtotal colectomy in patients undergoing surgery for primary or recurrent epithelial ovarian cancer. Oncol. Res. Treat. 2014. 37 (9). 448-54. doi: 10.1159/000366249.

Xiang L. et al. Distal pancreatectomy with splenectomy for the management of splenic hilum metastasis in cytoreductive surgery of epithelial ovarian cancer. J. Gynecol. Oncol. 2016. Nov. 27 (6). e62. doi: 10.3802/jgo.2016.27.e62.

Walter A.C., Manahan K.J., Geisler J.P. Morbidity of partial gastrectomy in primary ovarian cancer cytoreduction. J. Gynecol. Surg. 2010. 26 (4). 243-245. doi: 10.1089/gyn.2009.0067.

Eisenhauer E.L., Abu-Rustum N., Sonoda Y., Levine D.A., Poynor E.A., Aghajanian C. et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC–IV epithelial ovarian cancer. Gynecol. Oncol. 2006. 103. 1083-90. doi: 10.1016/j.ygyno.2006.06.028.

Gasparri M.L., Grandi G., Bolla D., Gloor B. et al. Hepatic resection during cytoreductive surgery for primary or recurrent epithelial ovarian cancer. J. Cancer. Res. Clin. Oncol. 2016. Jul. 142 (7). 1509-20. doi: 10.1007/s00432-015-2090-3.

Costantini B., Vizzielli G., Fanfani F., D'Addessi A. et al. Urologic surgery in gynecologic oncology: a large single-institution experience. Eur. J. Surg. Oncol. 2014. Jun. 40 (6). 756-61. doi: 10.1016/j.ejso.2014.01.020.

Harter P., Sehouli J., Lorusso D. et al. LION: Lympha­denectomy in Ovarian Neoplasms — a prospective randomized AGO study group led gynecologic cancer intergroup trial. J. Clin. Oncol. 2017. 35 (15 Suppl). 5500. doi: 10.1200/JCO.2017.35.15.

Spiliotis J., Halkia E., Lianos E., Kalantzi N., Grivas A., Efstathiou E. et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann. Surg. Oncol. 2015. 22. 1570-5. doi: 10.1245/s10434-014-4157-9.

Van Driel W.J., Koole S.N., Sikorska K., Schagen van Leeuwen J.H., Schreuder H.W.R., Hermans R.H.M. et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N. Engl. J. Med. 2018. 378. 230-40. doi: 10.1056/NEJMoa1708618.

Valle S.J., Alzahrani N.A., Liauw W., Sugarbaker P.H. et al. Hyperthermic ntraperitoneal Chemotherapy (HIPEC) Methodology, drugs and bidirectional chemotherapy. Indian. J. Surg. Oncol. 2016. 7 (2). 152-159. doi: 10.1007/s13193-016-0498-0.

Sugarbaker P.H., van der Speeten K. Surgical techno­logy and pharmacology of hyperthermic perioperative chemotherapy. J. Gastrointest. Oncol. 2016. 7 (1). 29-44. doi: 10.3978/j.issn.2078-6891.2015.105.

Wang Y., Ren F., Chen P., Liu S. et al. Effects of CytoReductive surgery plus hyperthermic IntraPEritoneal chemotherapy (HIPEC) versus CytoReductive surgery for ovarian cancer patients: A systematic review and meta-analysis. Eur. J. Surg. Oncol. 2019. 45 (3). 301-309. doi: 10.1016/j.ejso.2018.10.528.

Федоренко З.П., Михайлович Ю.Й., Гулак Л.О. та ін. Рак в Україні, 2018–2019. Захворюваність, смертність, показники діяльності онкологічної служби. Бюлетень Національного канцер-реєстру України, № 21. ПП Поліум, 2020.