Antonios-Apostolos Tentes

Background/Objectives: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may modify the prognostic impact of established clinical and surgical factors in advanced ovarian cancer. A retrospective study was conducted to identify independent predictors of survival, recurrence patterns and major postoperative complications in the HIPEC setting. Methods: In total, 265 women with advanced-stage ovarian cancer operated on between 2015 and 2019 were included. Patients were treated with CRS, with or without HIPEC. Patients’ characteristics, oncological and follow-up information were collected. Results: In total, 62.3% underwent primary CRS, and 39.2% received HIPEC, with complete or near-complete cytoreduction (CC-0/1) achieved in 85.6%. Major complications (≥grade III) were recorded in 16.6% of the patients. HIPEC, high peritoneal cancer index (PCI), and greater intraoperative blood loss were found to independently increase the odds of major postoperative complications, while prior surgery was the only independent predictor of local-regional recurrence. The median follow-up was 34 months, with a median progression-free (PFS) and overall survival (OS) of 26 and 77 months, respectively. Multivariable analysis identified systematic lymphadenectomy and serous histology as independent predictors for PFS and also for OS, with the addition of CC-3. Survival analysis with Kaplan–Meier curves revealed that CRS plus HIPEC was associated with significantly better OS, but not PFS, compared with CRS alone. Conclusions: Systematic lymphadenectomy, serous histology, and absence of macroscopic gross residual disease emerge as key independent favorable prognostic factors in the HIPEC era, while prior surgery adversely affects loco-regional control. CRS plus HIPEC improved OS in this specific regimen’s perfusion protocol but was associated with higher major postoperative complications, underscoring the need for careful patient selection.

Background/Objectives: Hyperthermic intraperitoneal chemotherapy (HIPEC) was revealed as a promising adjunct to cytoreductive surgery (CRS) in the treatment of advanced epithelial ovarian cancer (EOC). This review evaluated the impact HIPEC had on survival outcomes, recurrence patterns and safety in patients that underwent HIPEC in conjunction with interval and secondary CRS for advanced and recurrent ovarian cancer. Methods: A thorough search was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar to identify relevant studies published until 1 January 2025. The studies were assessed for survival outcomes, recurrence patterns, safety, and quality of life. The risk of bias was evaluated using the ROB 2 tool for randomized and ROBINS-I for non-randomized articles. The results are presented narratively, highlighting key findings, comparing results and assessing inconsistencies and limitations. Results: HIPEC demonstrated significant improvements in progression-free survival (PFS) and overall survival (OS), particularly in cases with optimal cytoreduction (CC-0/CC-1). The recurrence patterns showed a reduction in peritoneal dissemination with HIPEC, although extraperitoneal recurrences were reported in some cases. Most studies reported comparable morbidity rates between HIPEC and non-HIPEC groups, with acceptable safety profiles. The variability in the HIPEC protocols and the limited quality-of-life and cost-effectiveness data were noteworthy limitations. Conclusions: HIPEC, when performed during interval or secondary CRS, offers survival benefits and can modify recurrence patterns in advanced EOC, although challenges related to protocol standardization, patient selection, and long-term outcomes persist. Future research should focus on multicenter trials with uniform protocols, long follow-up periods and patient-centered outcomes to further validate the role of HIPEC in clinical practice.

Purpose: The main objective of the study is to evaluate the effect of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of naïve ovarian cancer women undergoing complete or near-complete cytoreduction by assessing the overall survival, the disease-specific survival, and the disease-free survival. The secondary objective is the identification of prognostic indicators of survival and recurrence of these patients. Patients—Methods: Retrospective study of treatment in naïve women with locally advanced ovarian cancer treated with cytoreductive surgery (CRS) and HIPEC and compared with those who were treated with cytoreduction alone. Clinicopathologic variables were correlated to overall survival, disease-specific survival, and disease-free survival using Kaplan–Meier method, and the multivariate Cox proportional hazards regression models. Results: 5- and 10-year overall survival, disease-specific survival, and disease-free survival rates were significantly higher in patients treated with CRS and HIPEC. These patients were 67% less likely to die from any cause (adjusted hazard ratio, aHR = 0.33, p = 0.001), 75% less likely to die from cancer (aHR = 0.25, p = 0.003), and 46% less likely to develop recurrence (aHR = 0.54, p = 0.041) compared to patients treated with CRS alone. Moreover, the poor performance status (aHR = 2.96, p < 0.001), the serous carcinomas (aHR = 0.14, p = 0.007), and the morbidity (aHR = 6.87, p < 0.001) were identified as independent indicators of poor overall survival. The degree of differentiation (aHR = 8.64, p = 0.003) was identified as the independent indicator of disease-specific survival (aHR = 4.13, p = 0.002), while the extent of peritoneal carcinomatosis (aHR = 2.32, p < 0.001) as the independent indicator of disease-free survival. Conclusions: Treatment in naïve patients with locally advanced ovarian cancer undergoing CRS plus HIPEC appears to have improved overall, disease-specific, and disease-free survival.

Introduction and importance: There is evidence that patients with limited peritoneal carcinomatosis of pancreatic cancer or those with low burden of hepatic metastases are amenable to surgical resection. A case report of a patient with cancer of the pancreatic tail and synchronous peritoneal and hepatic metastases is presented. Case presentation: A male patient, 66 years old, underwent cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and radio-frequency ablation (RFA) for synchronous hepatic metastases simultaneously to distal pancreatectomy for adenocarcinoma of the pancreas. Adjuvant chemotherapy followed the R ₀ surgery. The patient remained disease free for 18 months, developed liver recurrence and died 28 months after the initial operation. Discussion: CRS plus HIPEC with synchronous ablation or resection of hepatic metastases may be used for the treatment of pancreatic cancer with synchronous peritoneal and hepatic metastases in highly selected patients. Conclusion: Further studies are needed to confirm whether patients with synchronous peritoneal and hepatic metastases are offered survival benefit from complex surgical intervention (CRS plus HIPEC combined with hepatic resection or RFA). Highlights:

Background: The purpose of this study was to record the incidence, and identify the prognostic variables of morbidity and mortality in patients with peritoneal malignancy undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: The files of patients with peritoneal malignancy who underwent CRS + HIPEC from 2015–2022 were retrieved. Morbidity and hospital mortality were recorded and correlated to a variety of clinical variables. Results: A total of 44/192 (22.9%) patients were recorded with postoperative complications. Grade 3 and 4 complications were 12.5%. The possible prognostic variables of morbidity were the extent of peritoneal malignancy and the number of suture lines. The mortality rate was 2.5% (5 patients). The number of FFP units, and peritonectomy procedures were identified as possible prognostic variables of hospital mortality. Conclusions: The morbidity rate in patients undergoing CRS + HIPEC is acceptable compared to morbidity of previous publications or major gastrointestinal surgical operations. The possible prognostic variables of morbidity are the extent of peritoneal malignancy, and the number of suture lines. The mortality rate is low. The possible prognostic variables of mortality are the number of FFP units, and the number of peritonectomy procedures.

Purpose: The purpose of the study is the presentation of the experience of one surgical team in patients with pancreatic cancer and peritoneal metastases treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and a review of the literature. Patients-Methods: The data of patients with pancreatic cancer and peritoneal metastases who underwent treatment with CRS plus HIPEC were analyzed. Clinical and histopathologic variables were correlated to survival, recurrence, and morbidity. Results: In 10 patients (6 men and 4 women), with a mean age of 54.5+12.2 (28-72) years, 13 cytoreductions and HIPEC were undertaken for pancreatic cancer and peritoneal carcinomatosis. Complications were recorded in 8 patients, and 2 patients died in the perioperative period. The 1- and 3-year overall survival rates were 76% and 18%, respectively, and the median survival was 28 months. The completeness of cytoreduction and the performance status were related to survival (p<0.05). The recurrence rate was 69.2%. The gender and the presence of ascites were related to recurrence (p<0.05). Ascites has been identified as a possible prognostic indicator of recurrence (p=0.027). Conclusion: There is evidence that CRS with HIPEC can increase survival in selected patients with pancreatic cancer and peritoneal metastases. Future studies are needed to identify the group of patients that will benefit from this treatment.

Patients with low-grade appendiceal mucinous carcinomas (LAMNs) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have a favorable prognosis. However, a subgroup of patients presents a clinically aggressive course with disease progression despite receiving treatment. The purpose of this study is to report the experience of clinically aggressive LAMN patients treated by the same team, and to present a review of the literature. The cases of four patients with clinically aggressive LAMNs were reviewed. Clinical and histopathological characteristics were re-examined. Recurrences and the time of recurrence, as well as the survival time, were recorded. These patients were four men with clinically aggressive LAMNs treated with CRS plus HIPEC. One of them underwent CC-0 surgery, two underwent CC-1 surgery, and one underwent CC-3 surgery. All patients received systemic chemotherapy after surgery. Recurrence was recorded in three of the patients within 4–23 months after the initial treatment. Two of the patients underwent secondary CRS. Three patients died of disease recurrence within 13–23 months, and one is alive with a disease relapse at 49 months after his initial surgery. LAMNs were identified in both the initial specimens and the specimens obtained during reoperation. The prognosis of LAMN patients treated with CRS plus HIPEC is favorable. A small number of patients present a clinically aggressive course that is unresponsive to any treatment. Molecular and genetic studies are required to identify this group of LAMN patients who have an unfavorable prognosis.

Patients with low-grade appendiceal mucinous carcinomas (LAMN) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have a favorable prognosis. A subgroup presents a clinically aggressive course with disease progress despite any treatment. The purpose of the study is to report the experience with clinically aggressive LAMN patients treated by the same team and review the literature. Four patients with clinically aggressive LAMN were reviewed. Clinical and histopathological characteristics were re-examined. Recurrences and the time of recurrence, as well as the survival time, were recorded. There were 4 men with clinically aggressive LAMN treated with CRS plus HIPEC. One of them underwent CC-0 surgery, two underwent CC-1, and one CC-3 surgery. All received systemic chemotherapy after surgery. Recurrence was recorded in 3 patients in 4-23 months after initial treatment. Two of them underwent secondary CRS. Three patients died of disease recurrence in 13-23 months, and one is alive with disease relapse 49 months after initial surgery. LAMN was identified in both initial specimens and in specimens of reoperation. The prognosis of LAMN patients treated with CRS plus HIPEC is favorable. A small number of them presents clinically aggressive course unresponsive to any treatment. Molecular and genetic studies are required to identify this group of LAMN patients who have an unfavorable prognosis.

Background The purpose of this study was to record the incidence, and identify the prognostic variables of morbidity and mortality in patients with peritoneal malignancy undergoing cytoreductive surgery (CRS) combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC).Methods The files of patients with peritoneal malignancy who underwent CRS + HIPEC from 2015–2022 were retrieved. Morbidity and hospital mortality were recorded and correlated to a variety of clinical variables.Results A total of 44/192 (22.9%) patients were recorded with postoperative complications. Grade 3 and 4 complications were 12.5%. The prognostic variables of morbidity were the extent of peritoneal malignancy and the number of suture lines. The mortality rate was 2.5% (5 patients). The number of FFP units, and peritonectomy procedures were identified as prognostic variables of hospital mortality.Conclusions The morbidity rate in patients undergoing CRS + HIPEC is acceptable. The prognostic variables of morbidity are the extent of peritoneal malignancy, and the number of suture lines. The mortality rate is low. The prognostic variables of mortality are the number of FFP units, and the number of peritonectomy procedures.

Background: Even after potentially curative resection the long-term survival of pancreatic cancer is poor. The local-regional failures are frequent. Previous studies have shown that adjuvant treatment with hyperthermic intra-operative intraperitoneal chemotherapy (HIPEC) may effectively control local disease. The objective of the study is to update the results of the prior publications by integrating data from recently accrued cases. Also, to revisit the clinical and pharmacological rationale for the intraperitoneal administration of chemotherapy in pancreatic cancer patients undergoing potentially curative resection. Methods: This is a prospective study of pancreatic cancer patients that underwent R₀ resection in combination with HIPEC-gemcitabine. Morbidity and mortality were recorded. Survival was calculated and the sites for recurrent disease were recorded. Results: The updated results for 33 patients that underwent treatment until 2016 and for 6 more patients that were included until 2018 were presented. The hospital mortality and morbidity rate were 5.1% (2 patients), and 28.2% (11 patients) respectively. The median and 5-year survival rate was 17 months and 24% respectively. With a median follow-up time of 13 months 23 patients (59%) were recorded with recurrence. Local regional failures were recorded in 4 patients (10.3%). Conclusions: HIPEC following R₀ resection is a feasible and safe adjuvant treatment for pancreatic cancer. The local-regional failures appear to be significantly decreased and to result in an increased overall survival. Further studies with combined intraperitoneal and systemic perioperative chemotherapy may serve to supplement our data with an increased benefit for patients having pancreas cancer resection.