Minimally Invasive Surgery With HIPEC Feasible for Advanced Ovarian Cancer

A recent analysis of the LANCE (laparoscopic cytoreduction after neoadjuvant chemotherapy) trial found that performing hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with minimally invasive surgery (MIS) for patients with advanced epithelial ovarian cancer (EOC) is feasible. Complete macroscopic tumor removal (R0 resection) rates were comparable between MIS and open surgery when combined with HIPEC (88.9% vs 80%), and while MIS was associated with fewer postoperative complications, shorter operative times, and reduced hospital stays, these differences were not statistically significant due to the small sample size.

HIPEC has demonstrated benefits in prior studies of interval cytoreductive surgery for advanced ovarian cancer, but its use in the context of MIS remains largely unexplored. The LANCE trial is a noninferiority, prospective randomized study assessing disease-free survival in patients undergoing MIS versus laparotomy after three or four cycles of neoadjuvant chemotherapy. This ancillary analysis sought to evaluate the feasibility of combining HIPEC with MIS and its impact on perioperative outcomes.

Eligible patients with normalized CA-125 levels post-neoadjuvant chemotherapy were randomized to undergo interval cytoreductive surgery via either MIS or laparotomy, with the goal of achieving complete macroscopic tumor removal (R0 resection). HIPEC administration followed institutional guidelines. A secondary analysis of the trial’s lead-in phase assessed perioperative outcomes among the first 100 patients, comparing those who received HIPEC with those who did not. Key surgical metrics, including operative time, hospital stay, and postoperative complications, were analyzed.

Among the 100 patients who underwent interval cytoreduction, 19 received HIPEC (9 via MIS and 10 via open surgery). Patients undergoing HIPEC had significantly longer operative times (442.4 vs 215.3 minutes, P < .001), higher surgical complexity scores (3.6 vs 2.3, P = .01), and longer hospital stays (6.3 vs 3.3 days, P < .001) compared with those who did not receive HIPEC. When stratified by surgical approach, there were no significant differences between MIS and open surgery in operative time (482 vs 402.9 minutes, P = .14), hospital stay (7.1 vs 5.4 days, P = .51), or postoperative complications (20% vs 0%, P = .46). Both approaches achieved high rates of R0 resection, with MIS at 88.9% and open surgery at 80%.

“MIS with HIPEC is feasible and is associated with similar R0 resection rates as laparotomy and HIPEC,” the authors concluded. “The differences in rates of postoperative complications, operative time and length of hospital stay favored MIS; however, the differences were not statistically significant, likely secondary to the small sample size of HIPEC patients in the pilot phase.”

Reference

Agusti N. Perioperative outcomes of hyperthermic intraperitoneal chemotherapy for patients enrolled in the feasibility phase of a randomized controlled trial: Laparoscopic cytoreduction After Neoadjuvant ChEmotherapy (LANCE). Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 11, 2025. https://www.sgo.org/events/annual-meeting/