Surgery for Ovarian Carcinomatosis

Yes, it can be. Stage III ovarian cancer is potentially curable if complete cytoreduction (CC-0) is achieved. With that approach and the right systemic treatment, five-year survival is above 50%. Recurrences are common, but many patients live for years with the disease under control, and a relapse does not rule out treating it again.

Optimal cytoreduction used to mean leaving residual tumour smaller than 1 cm; complete (CC-0) means leaving no visible disease. Today the aim is always complete cytoreduction, because the volume of tumour left at the end of surgery is the factor with most influence on survival. It is also why the surgical team's experience is decisive.

HIPEC is mainly indicated in interval surgery, the operation performed after neoadjuvant chemotherapy in stage III disease. That is the setting in which the OVHIPEC trial showed a survival benefit. Its role in primary surgery and in recurrence is still under evaluation, so the indication is decided case by case in a multidisciplinary meeting.

It depends on whether all the disease can be removed up front. When complete cytoreduction looks achievable, operating first (primary debulking surgery) is preferable. If the disease is very extensive, neoadjuvant chemotherapy followed by interval surgery achieves comparable results with fewer complications. The decision is made with imaging and, at times, a laparoscopy.

Yes, in selected cases. A recurrence can be operated on when it is platinum-sensitive, localised and the patient is in good general condition. The DESKTOP III trial showed a survival benefit in exactly that profile, identified by the AGO criteria. Outside those criteria surgery adds no advantage and treatment relies on chemotherapy.

BRCA1/2 mutations make the tumour respond better to platinum agents and to PARP inhibitors. That improves prognosis and changes maintenance treatment, with drugs such as olaparib or niraparib. Genetic testing is therefore indicated in every patient with ovarian cancer, and the result also has consequences for family screening.

Between 4 and 10 hours, depending on the extent of the disease and the number of resections and peritonectomies needed. It is a long but methodical operation: the aim is to remove all visible disease, not to shorten theatre time. If HIPEC is added, it takes about 90 minutes more within the same procedure.

This is major surgery: the main risks are bleeding, infection, a leak at the bowel join when intestine is resected, and thromboembolic complications. In centres with specific experience, mortality is below 3% and severe complications below 20%. The team's case volume is decisive in those figures.

The usual stay is 7 to 14 days. The first days may require monitoring in an intensive care unit, depending on how extensive the surgery was. The enhanced recovery (ERAS) programme we apply, with early mobilisation, early nutrition and pain control without excess opioids, shortens that time and reduces complications.

Because of volume and results: more than 500 cytoreductions for ovarian cancer and complete cytoreduction (CC-0) rates above 80%. Added to that are experience with HIPEC, a multidisciplinary team that decides every case and access to clinical trials. In this surgery, the number of cases a team treats translates directly into results.