Survival Outcomes Post-secondary Cytoreduction in Peritoneal Metastatic Cases from Ovarian Cancer: A Single Institute Study

Background/Aim: Ovarian cancer remains the most lethal gynecological malignancy, with approximately 200,000 new cases and 100,000 deaths reported globally each year. This study aimed to evaluate the impact of secondary cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC), on survival in patients with peritoneal metastatic ovarian cancer. Patients and Methods: A retrospective-analysis was performed for patients treated with secondary-cytoreduction at the St. George Peritonectomy Unit between 1997 and December 2024. A total of 66 cases were identified from a prospective departmental database. Patients were stratified based on Peritoneal Carcinomatosis Index (PCI) into two groups: PCI <20 and PCI ≥20. Survival outcomes and perioperative variables were analyzed. Results: Multivariate Cox regression revealed that morbidity grade significantly impacted overall survival [odds ratio (OR)=1.641, p=0.011]. Median survival for patients with PCI <20 was 52.4 months vs. 14.2 months for those with PCI ≥20, p<0.0001. In the PCI <20 group, median-survival was "Not-Reached" in CRS-HIPEC patients as compared to 36.3 months in Non-HIPEC patients, p=0.003. In the PCI ≥20 group, it was 16.7 months for the CRS-HIPEC-group vs. 5.66 months for the Non-HIPEC-group, p<0.0001. Post-operative intra-abdominal collections significantly affected survival, p=0.046. Perioperative renal impairment was high at 25% in the PCI ≥20 group compared to PCI <20, which had nil incidents p=0.005. And 12.5% of cases with PCI ≥20 had pancreatic-leak vs. nil incidents in the PCI <20 group, p=0.048. Conclusion: PCI is an independent prognostic indicator in patients with advanced ovarian cancer receiving secondary cytoreduction surgery. The addition of HIPEC offers a significant survival advantage, particularly in patients with high PCI, when performed at experienced centers in carefully selected cases.