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Table 1. Showing the demographic and clinical details with follow-up status
Patient Sl. No 1 Patient Sl. No 2 Patient Sl. No 3
Age (years) 45 46 29
Date of registration 08-05-2016 04-06-2018 27-06-2017
Prior surgery Staging laparotomy None None
FIGO stage IVA IVA IVA
NACT (cycles/regimen) 6#TP, 6#Gem + CDDP, 1#TP 12#TP 3#TP
Date of surgery 20-05-2019 08-11-2018 12-03-2018
Types of CRS Secondary CRS Interval CRS Interval CRS
CRS procedure Disease limited peritonectomy + omental TAH + BSO + B/L PLND + RPLND TAH + BSO + B/L PLND + RPLND + total
cake excision + terminal ileum and limited + total omentectomy + pouch of omentectomy + right diaphragmatic
right colon resection anastomosis douglas and liver deposit excision stripping + selective peritonectomy
CRS duration (min) 370 410 330
Blood loss (mL) 1150 600 450
PCI 23/39 2/39 15/39
HITAC drug Mitomycin Cisplatin Cisplatin
Drug dosage (mg) 30 100 100
Duration (min) 60 45 60
Temperature (°C) 42 42 42
Perfusate Normal saline Normal saline Normal saline
Perfusate volume (L) 2.5 3.0 2.5
CC score 1 0 0
Comorbidity Cl. Dindo II Cl. Dindo III Cl. Dindo II
Adj chemotherapy 3#TP 6#TP + Bev 3#TP
Follow up status Alive & disease-free Alive with disease Alive & disease-free
Sl. No: serial number; FIGO: International Federation of Gynecology and Obstetrics; NACT: neoadjuvant chemotherapy; TP: Paclitaxel/
Carboplatin; CDDP: Cisplatin; TAH: total abdominal hysterectomy; BSO: bilateral salpingo-oophrectomy; B/L PLND: bilateral pelvic
lymph node dissection; PAND: paraaortic node dissection; CRS: cytoreduction surgery; PCI: peritoneal carcinomatous index; HITAC:
hyperthermic thoracoabdominal chemotherapy; CC score: completeness of cytoreduction score; Cl. Dindo: Clavien Dindo score; Adj:
adjuvant; Bev: Bevacizumab

Goal-directed fluid therapy is desirable for fluid management. Monitoring for fluid management is
routinely done using urine output measurement and non-invasive methods such as cardiac output
monitors for assessing the fluid status to guide management. Multimodal analgesia is required for optimal
outcomes. The use of thoracic epidural analgesia with local anesthetic and opioids appears to be acceptable
in the current study. Coagulopathy needs to be identified and corrected as necessary. The use of point
of care tools for assessing coagulopathy remains promising. Postoperative monitoring is crucial as these
patients continue to have various physiological changes for days in the postoperative period. The patient
should be monitored closely for fluid balance, hemodynamic fluctuations, renal impairment, coagulopathy
and electrolyte imbalances. Such patients also need DVT prophylaxis in the postoperative period using
pharmacological and/or mechanical measures.

RESULTS
CRS with HIPEC and HITAC were performed in three patients with ovarian carcinoma and peritoneal
carcinomatosis after neoadjuvant chemotherapy.

Patients were 29-46 years with a mean age of 40 years. All patients resided in urban localities and were of
middle class socioeconomic status.

Patient serial number “1” is a 45-year-old female with known hypothyroidism. She underwent staging
laparotomy at another institution for ovarian malignancy in December 2015 and histopathology was FIGO
stage IB. The patient did not undergo any adjuvant chemotherapy. Six months later, she self-referred to our
tertiary centre in May 2016 with symptoms of cough, breathlessness and abdominal distension and was
diagnosed as FIGO stage IVA, recurrent ovarian carcinoma. The patient underwent chemotherapy with