Is peritonectomy and hyperthermic intraperitoneal chemotherapy a new standard of treatment for advanced epithelial ovarian cancer?

Ovarian cancer is the leading cause of death due to gynaecological malignancy with a five-year relative survival of only 20-30% for Australian women with stage 3 and 4 disease. Most cases present with spread of cancer cells outside the pelvis to the peritoneal surfaces of the abdomen and associated viscera. Efforts to improve survival from advanced disease have therefore led to more extensive cytoreductive surgery, including the use of peritonectomy surgery, which is usually combined with hyperthermic intraperitoneal chemotherapy (HIPEC). There is an increased interest in this treatment approach by gynaecological oncologists, particularly after the results of a recent randomised controlled trial (RCT) from the Netherlands showed improved survival in women who were given HIPEC at the time of cytoreductive surgery for primary disease. This article discusses the technique of peritonectomy and HIPEC, the evidence for its use, and the potential role of this treatment approach for advanced epithelial ovarian cancer in Australian centres.