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Updated: Feb 28, 2026
Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma
Published on: January 22, 2022
A Meta-Analysis on the Long-Term Impact of Cytoreductive Surgery Plus HIPEC for Ovarian Cancer with Peritoneal
Dan Brebu1,2, Mircea Șelaru3,4, Ionut Flaviu Faur1,2
1IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania.
Background:
The benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in ovarian cancer with peritoneal metastasis remains debated outside selected indications. We performed a systematic review and meta-analysis to quantify survival, perioperative morbidity, and completeness of cytoreduction using study-level data.
Methods:
PubMed/MEDLINE, Embase, and Web of Science were searched. Eligible English-language studies included ovarian cancer patients undergoing CRS plus HIPEC and reported at least one of the following: overall survival (OS), progression-free survival (PFS), Grade III-IV complications, or CC-0 rate. Random-effects meta-analyses were conducted using inverse-variance pooling. For HR outcomes, DerSimonian-Laird τ2 with Hartung-Knapp confidence intervals was applied. Proportions were pooled using logit transformation (PLOGIT) with random-effects models.
Results:
Twelve studies (n = 567) were included. Only two studies provided extractable HRs for OS and PFS (n = 217). CRS plus HIPEC was associated with improved OS (HR 0.68, 95% CI 0.52-0.90, p = 0.0023; I2 = 0%; prediction interval 0.14-3.34) and improved PFS (HR 0.70, 95% CI 0.31-1.57, p = 0.0007; I2 = 0%; prediction interval 0.18-2.66). Across 12 studies (n = 563), the pooled Grade III-IV complication rate was 0.18 (95% CI 0.14-0.22; I2 = 16.3%; prediction interval 0.12-0.26). In 10 studies (n = 385), the pooled CC-0 rate was 0.87 (95% CI 0.79-0.92; I2 = 46.7%; prediction interval 0.66-0.96).
Conclusions:
CRS plus HIPEC shows a favorable signal for OS and PFS in the limited HR-eligible evidence and appears feasible, with a pooled severe complication rate of ~18% and high CC-0 rates. Current data support HIPEC primarily as a targeted intensification strategy in carefully selected patients, while broader adoption requires additional randomized, context-specific evidence.
