Highlight
- Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) post-primary treatment for advanced epithelial ovarian cancer (EOC) is feasible and safe.
- No conversions to laparotomy or serious perioperative complications occurred, highlighting minimally invasive benefits.
- Grade 3/4 adverse events were limited to temporary myelosuppression, resolving within six weeks.
- Patient-reported quality of life improved post-procedure, supporting tolerability of consolidation laparoscopic HIPEC.
Study Background
Epithelial ovarian cancer remains a leading cause of gynecologic cancer mortality primarily due to its advanced stage at diagnosis and high relapse rates despite initial response to primary debulking surgery and platinum-based chemotherapy. Hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a promising adjunct to improve survival by delivering heated chemotherapy directly to the peritoneal cavity, enhancing cytotoxicity while limiting systemic toxicity. Traditionally administered during open cytoreductive surgery, HIPEC’s feasibility via minimally invasive approaches post-primary treatment is underexplored. This study addresses an unmet need for innovative consolidation therapies that may improve residual microscopic disease control without compromising safety or quality of life (QoL) in patients with advanced EOC who show no clinical evidence of disease following initial therapy.
Study Design
This prospective feasibility study enrolled ten consecutive patients with FIGO stage III to IVA epithelial ovarian cancer who demonstrated no clinical or biochemical evidence of disease following standard primary debulking surgery and adjuvant chemotherapy. Within 12 weeks of completing upfront treatment, patients underwent a second look laparoscopy (SLL) during which carboplatin-based HIPEC (800 mg/m2 for 90 minutes) was administered laparoscopically. The primary endpoints were feasibility and safety, assessed by procedure completion rate, need for conversion to laparotomy, adverse events (AEs) graded by CTCAE criteria, and perioperative outcomes. Secondary endpoints included longitudinal assessment of patient-reported quality of life using the FACT-O questionnaires over six months.
Key Findings
All patients successfully underwent laparoscopic second look with HIPEC administration, demonstrating 100% procedural feasibility and no need for conversion to an open surgical approach. There were no perioperative blood transfusions or intensive care admissions, and operative recovery was uneventful. Across the cohort, all patients experienced at least one grade 1 or 2 AE predominantly related to the chemotherapeutic administration, such as mild hematologic or gastrointestinal disturbances.
Half of the patients experienced grade 3 or 4 myelosuppression (leukopenia, thrombocytopenia, anemia), which resolved fully within six weeks post-intervention without requiring prolonged hospitalization or lasting sequelae. Importantly, there were no study-related mortalities during follow-up.
Quality of life, measured by FACT-O scores, showed significant improvement from a baseline mean of 123 to 137 at both three and six months post-procedure, reflecting not only preservation but potential enhancement of patient well-being after laparoscopic HIPEC consolidation. No deleterious impact on QoL was observed.
Expert Commentary
This study is notable for pioneering minimally invasive administration of HIPEC as a consolidation strategy in advanced EOC patients rendered clinically disease-free after initial treatment. The laparoscopic approach minimizes surgical trauma and enhances recovery compared to traditional open HIPEC delivery. Although chemotherapy-associated hematologic toxicity remains a concern, the manageable profile and transient nature of AEs suggest acceptable risk in this setting.
Given the limited sample size, further randomized controlled trials with larger cohorts are warranted to establish efficacy endpoints such as progression-free and overall survival. Additionally, integration of molecular biomarkers could stratify patients more likely to benefit from consolidation HIPEC.
The improvement in quality of life post-HIPEC contrasts with concerns that intensive intraperitoneal therapies compromise patient-reported outcomes, underscoring the potential clinical utility of this regimen. Current ovarian cancer treatment guidelines do not yet formally include laparoscopic HIPEC; however, evolving evidence may inform future recommendations on multimodal consolidation strategies.
Conclusion
Consolidation laparoscopic HIPEC after standard primary treatment in advanced epithelial ovarian cancer is feasible, safe, and well tolerated. This approach provides another viable option to deliver HIPEC, focusing on disease control while maintaining and even improving patients’ quality of life. Although preliminary, these findings support further clinical investigation into laparoscopic HIPEC as a promising adjunct in upfront EOC management. Definitive trials are needed to validate survival benefits and determine optimal patient selection.
Funding and ClinicalTrials.gov
The study was conducted without reported funding sources. Clinical trial registration details were not disclosed in the publication.
References
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