Interval debulking with HIPEC in patient with VP shunt

Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery has demonstrated survival benefits in advanced ovarian cancer. However, the safety of HIPEC administration in patients with indwelling ventriculoperitoneal (VP) shunts remains unknown, as no prior cases have been reported. Theoretical risks include shunt infection, chemical ventriculitis, and potential central nervous system (CNS) metastasis via retrograde flow through the shunt catheter. The absence of established management guidelines poses a significant challenge for clinicians treating ovarian cancer patients with concurrent VP shunts.

A 60-year-old G1P1 with a 6-year history of a programmable VP shunt for hydrocephalus secondary to cerebellar hemangioblastoma presented with high-grade serous ovarian carcinoma, FIGO stage IIIA2. Following neoadjuvant chemotherapy, she underwent interval debulking surgery with cisplatin-based HIPEC. A multidisciplinary approach was employed: neurosurgery externalized the VP shunt catheter from the peritoneal cavity and wrapped it in metronidazole-soaked gauze during HIPEC administration and the shunt was replaced at case completion. Postoperative vancomycin, cefepime, and metronidazole were provided for five days for meningitis prophylaxis. The patient experienced no shunt-related complications and was discharged on postoperative day 4. At 10-month follow-up, she demonstrated excellent oncologic response with CA-125 normalization and no evidence of shunt malfunction or CNS involvement.

This case demonstrates that HIPEC can be safely performed in patients with indwelling VP shunts when a multidisciplinary strategy incorporating intraoperative shunt externalization and antimicrobial prophylaxis is utilized. This approach expands treatment options for ovarian cancer patients with VP shunts who may otherwise be excluded from potentially beneficial HIPEC therapy.