Original Articles Factors Affecting Perioperative Outcomes After CRS and HIPEC for Advanced and Recurrent Ovarian Cancer: A Prospective Single Institutional Study Shveta Giri, MS, Swati Hb Shah, MS, DNB, Kanika Batra Modi, MD, Suhas K. Rajappa, MS, DNB, Himanshu Shukla, MS, Eliza Shrestha, MD, Vandana Jain, MD, Rupinder Sekhon, MD, and Sudhir Rawal, MS, DNB, MCh Abstract Objective: The aim of this research was to assess the perioperative outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancers and evaluate the factors having impacts on morbidity and mortality. Design: This was a prospective, single-institutional study. Materials and Methods: The study included all patients undergoing CRS and HIPEC from November 1, 2014 to December 31, 2015, at the Rajiv Gandhi Cancer Institute and Research Centre, in New Delhi, India. Patient characteristics, disease factors, and operative outcomes were analyzed using descriptive statistics, and the impact of these variables on perioperative outcomes was evaluated using a Chi-square test. Results: Twenty-five patients, with mean age, body mass index, and body surface area of 48.7 years, 24.8kg/m 2 , and 1.592 m 2 , respectively, underwent primary (32%) or secondary (68%) CRS with HIPEC at a mean tem- perature of 42.5°C for 90 minutes. On average, time to oral feeds, intensive-care unit stay, and hospital stay were 3.96, 5.04, and 7.96 days, respectively. Major morbidity (Common Toxicity Criteria for Adverse Events grades 3–5) was seen in 5 patients and was significantly higher in patients aged >50 years ( p = 0.040) or with other comorbidities ( p = 0.044). Minor complications, including all chemotherapy-related complications, were seen in 36% patients with a slightly higher risk in suboptimally debulked patients. Two patients succumbed to disease in the perioperative period and were seen to have significantly longer surgeries ( p = 0.045). No other parameters were seen to affect the perioperative outcomes. Conclusions: CRS with HIPEC is feasible and safe for advanced and recurrent ovarian cancer. Patient’s age, comorbidity, and surgery duration affect perioperative outcomes and may be used to define selection criteria for HIPEC. ( J GYNECOL SURG 33:4) Keywords: ovarian cancer, cytoreductive surgery, HIPEC Introduction E pithelial ovarian cancer (EOC) is one of the com- monest and most morbid gynecologic malignancies. The subtle symptoms and its aggressive nature leading to pre- sentation at an advanced stage may be the reason for a poor prognosis. The gravity of the situation is delineated by the fact that 75% of these patients have initial stage III or IV. 1 The standard treatment is upfront cytoreductive surgery (CRS) followed by platinum-based adjuvant chemotherapy. 2 Though aggressive surgery and chemotherapy have brought a tremendous improvement in the course of ovarian cancer in recent years, 5-year overall survival remains dismal. 3 Ninety percent of suboptimally debulked and 70% of optimally debulked patients relapse within 18–24 months following primary treatment. 4,5 Despite being one of the most chemo- sensitive solid malignancies, with a complete response in up to 80% of patients, such a high relapse rate points toward a need for a novel form of treatment. 6 Intraperitoneal (i.p.) chemotherapy came as a new hope for treating patients who faced the grim situation of peri- toneal surface malignancies. Consideration of peritoneal metastasis as loco regional rather than metastatic disease by Spratt et al. 7 and Sugarbaker et al. strengthened this idea. 8 Instillation of chemotherapy via the i.p. route promises not only a diminution in systemic adverse effects but also Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India. JOURNAL OF GYNECOLOGIC SURGERY Volume 33, Number 1, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/gyn.2016.0077 4