High-grade serous carcinoma
Accounts for 70% of ovarian cancers. High initial sensitivity to chemotherapy but frequent recurrences. A good candidate for cytoreduction + HIPEC.
Reviewed by Dr. Juan José Torrent · Updated: April 30, 2026
Advanced ovarian cancer
Peritoneal carcinomatosis of ovarian origin
Ovarian cancer is the most common cause of peritoneal carcinomatosis in women. With optimal cytoreductive surgery and HIPEC, 5-year survival rates exceed 50% in selected patients. Our multidisciplinary team performs primary, interval and salvage surgery according to the stage.
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Clinical summary
Peritoneal carcinomatosis from ovarian cancer is treated with complete cytoreductive surgery and HIPEC, with 5-year survival above 50% in selected patients. At Quenet-Torrent Institute (Barcelona · Madrid), the team of Dr. Quenet, Dr. Torrent and Prof. González Bayón performs primary, interval and salvage surgery according to the stage.
EXPLANATORY VIDEO
Carcinomatosis of ovarian origin
Our specialists explain the treatment of ovarian cancer with peritoneal spread, from staging to interval surgery and the treatment of recurrence.
- Primary vs. interval cytoreductive surgery
- The role of HIPEC in ovarian cancer (OVHIPEC study)
- Management of peritoneal recurrence
What is peritoneal carcinomatosis of ovarian origin?
Peritoneal carcinomatosis of ovarian origin is the most common form of spread of epithelial ovarian cancer. About 75% of patients with ovarian cancer are diagnosed at advanced stages (FIGO III-IV), with peritoneal involvement already present.
Unlike other tumors in which carcinomatosis indicates a poor prognosis, in ovarian cancer peritoneal spread is potentially curable with optimal cytoreductive surgery. Achieving complete cytoreduction (CC-0, no visible residual disease) is the most important prognostic factor, with 5-year survival above 50%.
Ovarian cancer has a particular biological behavior: it tends to remain confined to the peritoneal cavity for much of its course, which makes it especially suitable for locoregional treatments such as HIPEC.
Symptoms of peritoneal carcinomatosis of ovarian origin
Peritoneal spread of ovarian cancer usually develops insidiously. The most common symptoms are progressive abdominal swelling and fluid build-up in the peritoneal cavity (ascites), together with diffuse pelvic or abdominal pain, early satiety, loss of appetite and unintentional weight loss.
As the disease progresses there may be changes in bowel rhythm, a feeling of pressure on the bladder or urinary problems from compression of adjacent structures, and severe tiredness. Since these symptoms are non-specific and are confused with benign digestive or gynecological conditions, the diagnosis is often made at advanced stages. When a woman has abdominal swelling together with ascites, especially after menopause, an urgent oncological assessment is essential.
Causes and risk factors of peritoneal carcinomatosis of ovarian origin
Peritoneal carcinomatosis of ovarian origin is a direct consequence of the progression of epithelial ovarian carcinoma, in particular the high-grade serous subtype, which tends to spread by direct seeding onto the peritoneal surfaces from early stages. This form of spread is the most characteristic of ovarian cancer and explains why peritoneal involvement is already present in about 75% of cases at diagnosis.
The main risk factors associated with the underlying ovarian cancer include older age and postmenopausal status, germline mutations in the BRCA1 or BRCA2 genes, Lynch syndrome and other hereditary colorectal cancer syndromes, a family history of ovarian or breast cancer, pelvic endometriosis and certain hormonal factors such as never having given birth or prolonged hormone replacement therapy. Identifying these factors helps guide genetic screening and follow-up in women at higher risk.
Histological types and peritoneal behavior
Not all ovarian tumors behave in the same way. The histological subtype changes how treatment is planned.
Low-grade serous carcinoma
Slower growth but a poorer response to chemotherapy. Cytoreductive surgery becomes especially important as the main treatment.
Endometrioid carcinoma
Often associated with endometriosis. Better overall prognosis, with a favorable response to adjuvant hormone therapy.
Mucinous carcinoma
Less common (3-5%). Behavior similar to gastrointestinal tumors. Lower sensitivity to chemotherapy, greater dependence on complete surgery.
Clear cell carcinoma
Associated with endometriosis. Resistant to chemotherapy, so complete cytoreduction weighs heavily on the prognosis.
Malignant Brenner tumor
Very uncommon. A surgical approach similar to serous carcinoma, with individual systemic treatment.
Treatment strategies
Multimodal approach to advanced ovarian cancer
Treatment combines surgery and chemotherapy in a coordinated way. The order and timing of each depend on the case.
Primary cytoreductive surgery (PDS)
The treatment of choice when complete cytoreduction is expected. It is performed before chemotherapy in patients in good general condition with potentially resectable disease. Survival is better when CC-0 is achieved.
Neoadjuvant chemotherapy + interval surgery (IDS)
Indicated when the initial disease does not allow optimal cytoreduction. 3-4 cycles of carboplatin-paclitaxel reduce the tumor burden, making later complete surgery easier. The CHORUS and EORTC studies validate this approach.
HIPEC after cytoreduction (OVHIPEC study)
The Dutch OVHIPEC study showed a survival benefit from adding HIPEC with cisplatin after interval surgery. Median survival: 45.7 months vs 33.9 months without HIPEC.
Secondary cytoreductive surgery
In late recurrences (>12 months), with localized disease and good general condition, salvage surgery can offer long survival. The DESKTOP III study showed a significant benefit.
The importance of complete cytoreduction (CC-0)
In advanced ovarian cancer, achieving complete cytoreduction is the most important prognostic factor, even more than the initial stage or the histological subtype. The difference in survival is large:
CC-0 (no visible residue)
Median survival >60 months. 5-year survival rate: 50-60%. The goal of surgical treatment.
CC-1 (residue <2.5mm)
Median survival 40-50 months. A significant reduction compared with CC-0, but still with a surgical benefit.
Residue >1cm
Median survival 25-35 months. Suboptimal surgery offers less benefit than chemotherapy alone.
That is why surgery should be performed by a team specialized in ovarian cancer cytoreduction, able to carry out extensive procedures when needed.
Procedures in ovarian cytoreductive surgery
Achieving CC-0 often requires complex procedures. Our team has experience in all the techniques needed.
Hysterectomy and bilateral salpingo-oophorectomy
The basis of the operation. It includes removal of the uterus, ovaries and fallopian tubes together with the primary tumor.
Infracolic omentectomy
Complete removal of the greater omentum, a frequent site of tumor implants and "omental cake".
Pelvic and diaphragmatic peritonectomy
Stripping of the affected peritoneum. The domes of the diaphragm are frequent sites that require specialized technique.
Bowel resections
Rectosigmoidectomy, small bowel resection or hemicolectomy when there is direct tumor infiltration.
Splenectomy and splenic hilum resection
Needed when there are implants in the splenic hilum or the tail of the pancreas. It requires experience to avoid complications.
Pelvic and para-aortic lymphadenectomy
Debated in advanced stages. The LION study suggests omitting it if lymph nodes are clinically negative after neoadjuvant chemotherapy.
Scientific evidence
HIPEC in ovarian cancer: the OVHIPEC study
The OVHIPEC clinical trial, published in the New England Journal of Medicine (2018), studied the effect of adding HIPEC in advanced ovarian cancer.
Study design
245 patients with stage III ovarian cancer after neoadjuvant treatment, randomized to interval surgery with or without HIPEC (cisplatin 100mg/m², 40°C, 90 minutes).
Main results
Recurrence-free survival: 14.2 vs 10.7 months. Overall survival: 45.7 vs 33.9 months. A 33% reduction in the risk of death.
Safety
No significant differences in serious complications between the two groups. HIPEC did not increase the morbidity of surgery.
Current indication
HIPEC is recommended after interval surgery in stage III ovarian cancer. Ongoing studies are evaluating its benefit in primary surgery and recurrence.
Why ask for a second opinion on ovarian cancer?
Treatment of advanced ovarian cancer requires specialized experience that is not available at every center.
Assess resectability
What one center considers unresectable may be operable for a specialized team. The surgeon's case volume influences CC-0 rates.
Confirm the best strategy
Primary surgery or neoadjuvant treatment? Is she a candidate for HIPEC? Does it make sense to operate on a recurrence? A specialized team can help make these decisions.
Access to clinical trials
Some centers take part in studies with new drugs (PARP inhibitors, immunotherapy) that may benefit patients with limited options.
A real multidisciplinary assessment
Boards with gynecological oncologists, carcinomatosis surgeons, medical oncologists and radiologists specialized in peritoneal assessment.
WHY CHOOSE US?
Experience in advanced ovarian cancer
At Quenet-Torrent Institute we have performed more than 500 cytoreductions for ovarian cancer with peritoneal carcinomatosis.
High surgical volume
More than 500 cytoreductions for ovarian cancer performed. Higher case volume is associated with better oncological results.
CC-0 rate
We achieve complete cytoreduction in more than 80% of patients.
Integrated multidisciplinary team
Gynecological oncologists, carcinomatosis surgeons and oncologists working together on each case.
Experience in HIPEC
We apply HIPEC according to the OVHIPEC protocol, with specific equipment and training.
Management of recurrences
Individual assessment of recurrences to select candidates for salvage surgery with curative intent.
Prognosis of ovarian cancer with carcinomatosis
The prognosis of advanced ovarian cancer has improved significantly in recent decades thanks to advances in cytoreductive surgery, platinum-based chemotherapy and, more recently, PARP inhibitors and HIPEC.
The most important prognostic factors are:
- Complete cytoreduction (CC-0): The most decisive factor. 5-year survival >50%.
- Response to platinum: Platinum-sensitive patients have a better prognosis and more treatment options.
- BRCA status: BRCA1/2 mutations paradoxically confer a better prognosis because of greater sensitivity to chemotherapy.
- Histological subtype: Low-grade serous and endometrioid carcinomas have a better course.
Each patient's prognosis depends on how these factors combine in her case, and the team assesses it with her specific data.
Our team
Advanced ovarian cancer specialists
A multidisciplinary team with specific experience in the surgical treatment of ovarian cancer with peritoneal spread.
Dr. François Quenet
Oncological surgeon
View doctor: Dr. François Quenet"In advanced ovarian cancer, the quality of surgery determines the prognosis. Our goal is to achieve complete cytoreduction in every patient."
Dr. Juan José Torrent
Oncological surgeon
View doctor: Dr. Juan José Torrent"The combination of radical surgery and HIPEC has changed the paradigm of treatment for stage III ovarian cancer."
Prof. Luis González Bayón
Oncological surgeon
View doctor: Prof. Luis González Bayón"Patient selection and the timing of surgery are key. Not all patients benefit from the same approach."
Dr. Pablo Lozano Lominchar
Oncological surgeon
View doctor: Dr. Pablo Lozano Lominchar"Experience in procedures in the upper abdomen (diaphragm, splenic hilum, liver) is essential to achieve CC-0."
Dr. Clara Montagut
Medical oncologist
View doctor"Combining surgery, chemotherapy, PARP inhibitors and immunotherapy offers patients with ovarian cancer more options than ever."
Frequently asked questions about ovarian cancer with carcinomatosis
Answers to the most common questions from patients with advanced ovarian cancer.
Is stage III ovarian cancer curable?
Yes, it can be. Stage III ovarian cancer is potentially curable if complete cytoreduction (CC-0) is achieved. With that approach and appropriate systemic treatment, 5-year survival exceeds 50%. Recurrences are common, but many patients live for years with the disease under control, and a relapse does not prevent further treatment.
What is the difference between optimal and complete cytoreduction?
Optimal cytoreduction used to mean leaving residual tumor smaller than 1 cm; complete cytoreduction (CC-0) means leaving no visible disease. Today the goal is always complete cytoreduction, because the amount of tumor left at the end of surgery is the factor with the greatest influence on survival. This is also why the experience of the surgical team is decisive.
When is HIPEC indicated in ovarian cancer?
HIPEC is indicated mainly in interval surgery, performed after neoadjuvant chemotherapy in stage III. This is the setting in which the OVHIPEC study showed a survival benefit. Its role in primary surgery and in recurrence is still being evaluated, so the indication is decided case by case by the multidisciplinary board.
Is it better to have surgery before or after chemotherapy?
It depends on whether all the disease can be removed from the start. When complete cytoreduction seems achievable, operating first (primary surgery, or PDS) 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 the imaging tests and, sometimes, a laparoscopy.
Can a recurrence of ovarian cancer be operated on?
Yes, in selected cases. A recurrence of ovarian cancer can be operated on when it is platinum-sensitive and localized and the patient remains in good general condition. The DESKTOP III study showed a survival benefit precisely in that profile, which is identified with the AGO criteria. Outside those criteria, surgery offers no advantage and treatment relies on chemotherapy.
How important is the BRCA mutation?
BRCA1/2 mutations make the tumor respond better to platinum drugs and to PARP inhibitors. This improves the prognosis and changes maintenance treatment, with drugs such as olaparib or niraparib. That is why genetic testing is indicated for all patients with ovarian cancer, and its result also has consequences for testing the family.
How long does cytoreductive surgery take?
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 the time in the operating room. If HIPEC is added, the procedure takes about 90 more minutes within the same operation.
What complications can the surgery have?
It is major surgery: the main risks are bleeding, infection, leakage at the bowel join when bowel is resected, and thromboembolic complications. At centers with specific experience, mortality is below 3% and serious complications below 20%. The team's case volume is decisive in these figures.
How long is the hospital stay?
The usual stay is 7 to 14 days. The first days may require monitoring in an intensive care unit, depending on the extent of surgery. The ERAS enhanced recovery program we apply, with early mobilization, early nutrition and pain control without excess opioids, shortens that time and reduces complications.
Why choose Quenet-Torrent for my treatment?
Because of volume and results: more than 500 cytoreductions for ovarian cancer and complete cytoreduction (CC-0) rates above 80%. Added to this are experience with HIPEC, a multidisciplinary board that decides each case and access to clinical trials. In this surgery, the number of cases a team treats translates directly into results.
Where to treat peritoneal carcinomatosis of ovarian origin?
We operate in two private hospitals in Spain. The same medical team treats you in Madrid and in Barcelona, with the same surgical and oncological protocols.
Madrid
Memorial Publio Cordón Hospital
Private hospital in Pozuelo de Alarcón with a multidisciplinary team specialised in digestive surgical oncology.
View Memorial Publio Cordón Hospital
Barcelona
Centro Médico Teknon
Private hospital in Barcelona where the team performs high-complexity surgical oncology.
View Centro Médico Teknon
Verified reviews
See on Google
4.5/5
What our patients say
L
4 weeks ago
5/5
Wonderful surgical team, among the best out there. Dr. Torrent (expert in peritoneal carcinomatosis) is an exceptional surgeon and an even better person. His coordinator is super kind, fast and efficient. The personal care is excellent and so are the results. This is of vital importance for cancer patients.
K
5 months ago
5/5
In the public healthcare system they gave my father a maximum of one year to live. They only offered him chemo and no hope, said it was impossible, that nothing could be done. He had several tumors inside the peritoneal sac with metastases. A year and a half later he is clean, completely cured. His latest PET scan came back clean. We are very happy. Thanks to Dr. Torrent and his team. THANK YOU.
M
A year ago
5/5
Excellent professionals, especially Dr. Torrent, attentive at all times to the patient (my wife), operated for peritoneal pseudomyxoma. They helped us with all our needs since we came from outside Barcelona. Thank you Elisabeth. We are very grateful to Quenet Torrent Institute, thank you for everything.
P
2 years ago
5/5
I am a 63-year-old patient. They detected adrenal gland cancer and told me there was nothing to be done. I sought a second opinion and they told me about the Quenet Torrent team, specialists in complex operations. Dr. Torrent, from the first moment, told me they could operate. They operated and removed a large tumor mass. I spent a week in the ICU and a month on the ward. Every day he came morning and evening, no matter Saturday or Sunday. Never throw in the towel. I am happy to have found these professionals who gave me my life back. Thank you.
I
3 years ago
5/5
Many thanks for your attention. Dr. Torrent always attentive, involved and decisive. The reception staff very pleasant and always offering the best option. 100% RECOMMENDED. THANK YOU.
M
5 years ago
5/5
Dr. Torrent helped me make the best decision at a difficult moment. I think he is a great professional and a person capable of accompanying you and putting himself in another's shoes. Thank you for everything.
F
6 years ago
5/5
I have peritoneal carcinomatosis. When I sent my diagnosis to every center, practically all of them agreed on palliative chemo with little survival time, since I had a very aggressive type of cell. Until we reached Dr. Quenet, Dr. Torrent and their team. I can only confirm what their CV announces: they are far ahead of the rest. They saved my life, because during the operation the harmful cells that everyone had diagnosed, and that were the reason nobody would operate on me, were not there. This intervention has become the best investment of my life.
M
6 years ago
5/5
The best decision of my life was finding this excellent team of surgeons who saved my husband's life. At a prestigious international clinic in Madrid he was given up for lost with advanced peritoneal carcinomatosis from appendiceal cancer, and thanks to them, the best professionals in this field, he was operated on very successfully. A perfect recovery with no complications, because they were on top of his progress at all times. They have a great quality: from the start they were very honest and close. I can only be deeply grateful; we went to buy time and thanks to them my husband got his life back.
E
7 years ago
5/5
Dr. Torrent is a brilliant surgeon and a very approachable and warm doctor, whose manner reveals all the qualities that make him a great person and professional: perseverance, innate curiosity and a desire to learn, humility, sincerity and empathy. Going through an operation is undoubtedly an intense experience, physically and emotionally, in which anxieties arise and you feel very vulnerable. All of that is normal, and as his former patient I can say that his care and professionalism throughout the process were absolutely exceptional. I felt very supported by him, with the confidence of knowing I was in the best hands. I will always be grateful to him. Moltes gràcies Dr. Torrent!
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