Evaluating the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) as an adjunct to surgery for advanced ovarian cancer: A systematic review and meta-analysis of randomized controlled trials.

Abstract

e17579 Background: Advanced ovarian cancer remains a significant challenge in gynecologic oncology, with a 5-year survival rate of approximately 30% for patients with advanced disease. The use of surgery is the standard of care for advanced ovarian cancer, however, aim of this meta analysis is to detect efficacy and safety of Hyperthermic intraperitoneal chemotherapy (HIPEC) as an adjunct to surgery for advanced ovarian cancers. Methods: We conducted a systematic search on PubMed, Embase, Clinicaltrials.gov, and the Cochrane databases from inception up to 27 th December , 2024 focusing on randomized controlled trials (RCTs) reporting therapeutic as well as safety outcomes of integrating HIPEC to surgery for advanced ovarian cancers. Dichotomous outcomes were presented as risk ratios (RR) with 95% confidence intervals (CI). The inter-study heterogeneity was dealt with random effect model. All the calculation were performed using RevMan 5.4. A P value of < 0.05 was considered statistically significant. Results: 8 RCTs with patient population of 1545 were included in this meta-analysis. Primary outcomes included Overall survival (OS) and Progression free survival (PFS) at 5 years. Analysis showed that use of HIPEC with surgery significantly improves the OS at 5 years (RR:1.27, 95% CI [1.09, 1.49], p = 0.003 (I 2 = 40%)). However, analysis did not yield any significant results for PFS at 5 years (RR:1.01, 95% CI [0.94, 1.10], p = 0.72 (I 2 = 51%)). Among the secondary outcomes, a significant increase in the risk of thrombocytopenia was observed in patients receiving HIPEC along with surgery compared to those undergoing surgery alone (RR:1.37, 95% CI [1.04, 1.82], p = 0.03 (I 2 = 0%)). However, there was no significant results reported for leukopenia (RR:1.08, 95% CI [0.90, 1.291], p = 0.4 (I 2 = 0%)). Lastly, analysis did not yield any significant results for constipation as an outcome in both treatment groups (RR:0.82, 95% CI[0.62, 1.08], p = 0.16 (I 2 = 0%)). Conclusions: HIPEC as an adjunct to surgery demonstrates a significant survival benefit as compared to surgery alone in patients with advanced ovarian cancer.