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GYNAECOLOGIC ONCOLOGY
Ovarian Cancer Debulking + HIPEC
Comprehensive surgical management of ovarian cancer — primary and interval debulking surgery combined with HIPEC to achieve optimal cytoreduction and maximise survival in advanced ovarian cancer.
ABOUT THE PROCEDURE
Optimal Debulking — The Cornerstone of Ovarian Cancer Treatment
Surgical debulking (cytoreductive surgery) is the single most important prognostic factor in advanced ovarian cancer. The goal is complete visible cytoreduction — the removal of all tumour deposits greater than 1mm (R0 or optimal debulking with no visible residual disease). Patients who achieve complete cytoreduction have dramatically better survival than those with any residual disease.
Primary debulking surgery (PDS) is performed upfront in patients who present with resectable disease and good performance status. Neoadjuvant chemotherapy followed by interval debulking surgery (IDS) is preferred in patients with disease too extensive for upfront complete resection.
The van Driel et al. NEJM trial (2018) demonstrated that adding HIPEC to interval debulking surgery improved survival by 12 months (median OS 45 months vs 33 months) with no increase in serious adverse events, establishing CRS + HIPEC as a new standard of care for stage IIIC ovarian cancer.
How It Is Performed
Staging & Neoadjuvant Decision
FIGO staging by CT/MRI. CA-125 monitoring. Decision for primary or interval debulking based on disease extent, SCS score, and performance status. Neoadjuvant platinum-based chemotherapy for IDS pathway.
Systematic Pelvic Cytoreduction
Total hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, resection of involved bladder peritoneum and rectosigmoid if needed (posterior pelvic exenteration).
Abdominal Cytoreduction
Greater and lesser omentectomy, diaphragmatic peritonectomy, clearance of disease from paracolic gutters, liver hilum, and subhepatic/subphrenic spaces to achieve CC-0.
HIPEC (if eligible)
Immediately following complete cytoreduction, HIPEC with cisplatin (75mg/m²) at 41–42°C for 60 minutes. Achieves destruction of microscopic residual peritoneal disease.
CANDIDACY
Who May Benefit?
Stage IIIB/IIIC high-grade serous ovarian cancer
The most common scenario. Both upfront and interval debulking with HIPEC are appropriate in eligible patients achieving CC-0 resection.
Recurrent ovarian cancer (platinum-sensitive)
Selected patients with platinum-sensitive recurrent ovarian cancer and limited peritoneal disease may benefit from secondary cytoreduction.
Other ovarian malignancies
Endometrioid, clear cell, and mucinous ovarian cancers, as well as fallopian tube and primary peritoneal cancers, follow similar surgical principles.
BRCA-mutated ovarian cancer
BRCA1/2 mutation carriers often have more chemo-sensitive disease and may be particularly good candidates for complete debulking with HIPEC.
ESSO FELLOW · HIPEC + CRS
ESSO Fellowship Training in Ovarian Cancer Debulking + HIPEC
Dr. Imaduddin trained specifically in ovarian cancer cytoreductive surgery and HIPEC during his ESSO Fellowship at University Hospital Hannover under Prof. Dr. Beate Rau — one of the world’s foremost authorities in peritoneal oncology.
Consult Dr. Imaduddin for Ovarian Cancer Surgery
Ovarian cancer surgical outcomes are profoundly influenced by surgical expertise. Dr. Imaduddin provides specialist evaluation for ovarian cancer debulking and HIPEC in Hyderabad.