1^stEvidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer

Abstract

Ovarian cancer (OC) remains relatively rare, although it is among the top 4 causes of cancer death for women younger than 50. The aggressive nature of the disease and its often late diagnosis with peritoneal involvement have an impact on prognosis. The current scientific literature presents ambiguous or uncertain indications for management of peritoneal carcinosis (PC) from OC, both owing to the lack of sufficient scientific data and their heterogeneity or lack of consistency. Therefore, the Italian Society of Surgical Oncology (SICO), the Italian Society of Obstetrics and Gynaecology, the Italian Association of Hospital Obstetricians and Gynaecologists, and the Italian Association of Medical Oncology conducted a multidisciplinary consensus conference (CC) on management of advanced OC presenting with PC during the SICO annual meeting in Naples, Italy, on September 10-11, 2015. An expert committee developed questions on diagnosis and staging work-up, indications, and procedural aspects for peritonectomy, systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy for PC from OC. These questions were provided to 6 invited speakers who answered with an evidence-based report. Each report was submitted to a jury panel, representative of Italian experts in the fields of surgical oncology, gynecology, and medical oncology. The jury panel revised the reports before and after the open discussion during the CC. This article is the final document containing the clinical evidence reports and statements, revised and approved by all the authors before submission.

Hyperthermic Intraperitoneal Chemotherapy Versus Systemic Chemotherapy in Recurrent Platinum-Sensitive Ovarian Cancer NCI Case Control Study

“…The most common surgery related complications included anastomotic leakage, intestinal perforation, intraperitoneal hemorrhage and abdominal evisceration (Cavaliere et al, 2017). In our study no patient had anastomotic leakage, one patient had iatrogenic small intestinal tear (6.6%), one had intraabdominal hemorrhage (6.6%), and one had abdominal evisceration (6.6%).…”

“…In the 1st Evidence-based Italian consensus conference on CRS and HIPEC for peritoneal carcinomatosis from ovarian cancer which was held in 2015 and published in 2017, the panel adopted the DESKTOP scores for prediction of completion of cytoreduction (PS 0-1, absence of residual tumor from the primary surgery and absence of ascites). This tool score predicts complete cytoreduction in 76% of the patients undergoing cytoreductive surgery (Cavaliere et al, 2017). The Faggotti's study adopted 2 criteria of the DESKTOP score (PS 0-1 and absence of ascites).…”

“…In the 1st Evidence-based Italian consensus conference mentioned before the panel declared that the rate of complications reported in maximal CRS with HIPEC in primitive or relapse OC are varied ranged between 0% and 65.2% (Cavaliere et al, 2017) and these data are level 1 evidence. The major complications in our study reached 46.5% matching the rate mentioned in this consensus.…”

“…In our study the median OS was 36months, the median disease free survival was 6 months and 5years OS was 20%. The Italian consensus mentioned before adopted this review considering it level 2 evidence (Cavaliere et al, 2017).…”

Cytoreductive surgery (CRS) with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) versus standard of care (SoC) in people with peritoneal metastases from colorectal, ovarian or gastric origin: protocol for a systematic review and individual participant data (IPD) meta-analyses of effectiveness and cost-effectiveness

“…Although CRS+HIPEC has the potential to improve the survival and health-related quality of life (HRQoL) in people with peritoneal metastases [14,19,20], there have been concerns raised about its safety. Reports have shown a 30-day mortality after CRS+HIPEC of 1-3% [6], and a major complication rate of 32% [6,21], albeit that local audit data from high volume centres suggest that mortality and morbidity rates are somewhat less than in these reports (local audit data). The average costs of CRS+HIPEC per patient varies from about 20,000 USD to 80,000 USD [22][23][24][25][26][27][28].…”