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Ray et al. J Cancer Metastasis Treat 2020;6:9 Journal of Cancer
DOI: 10.20517/2394-4722.2020.16 Metastasis and Treatment

Technical Note Open Access

Cytoreductive surgery with hyperthermic
thoracoabdominal chemotherapy in stage IV ovarian

cancer - a technical description

Mukur Dipi Ray , Raghuram Kuppusamy , Navin Kumar , Rakesh Garg 2
1
1
1
1 Department of Surgical Oncology, Dr BRA-IRCH, AIIMS, New Delhi 110029, India.
2 Department of Onco-anesthesiology and Palliative Medicine, Dr Dr. B.R.A Institute-Rotary Cancer Hospital, AIIMS, New Delhi
110029, India.
Correspondence to: Dr. Mukur Dipi Ray, MS, FRCS, PhD, Scholar, Department of surgical oncology, Dr BRA-IRCH, AIIMS,
Ansari Nagar, New Delhi 110049, India. E-mail: dr_mdray@yahoo.com; Navin Kumar, MS, MCh Trainee, Department of surgical
oncology, Dr BRA-IRCH, AIIMS, Ansari Nagar, New Delhi 110049, India. E-mail: navin2k1@gmail.com

How to cite this article: Ray MD, Kuppusamy R, Kumar N, Garg R. Cytoreductive surgery with hyperthermic thoracoabdominal
chemotherapy in stage IV ovarian cancer - a technical description. J Cancer Metastasis Treat 2020;6:9.
http://dx.doi.org/10.20517/2394-4722.2020.16

Received: 18 Feb 2020 First Decision: 23 Mar 2020 Revised: 26 Mar 2020 Accepted: 3 Apr 2020 Published: 17 Apr 2020
Science Editor: Pravin D. Potdar Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Systemic chemotherapy for peritoneal disease in ovarian carcinoma is associated with a recurrence rate of
more than 75%, and most of the cases are confined to the peritoneal cavity. The propensity of locoregional
treatment failure has paved the way for the discovery of cytoreductive surgery with intra-cavitary chemotherapy.
Cytoreductive surgery (CRS) is the present-day treatment modality for a variety of peritoneal carcinomatosis
including ovarian cancer, and multi-visceral resection is critical for completion of CRS. In cases of diaphragmatic
infiltration by tumor deposits, partial resection leads to a diaphragmatic rent, which can be used for the perfusion
of chemotherapeutic drugs into the pleural cavity. Disease transmission from the peritoneal to pleural cavity is a
poor prognostic factor however. Hence, intrathoracic hyperthermic chemotherapy may be a reasonable treatment
option for ovarian carcinoma with malignant pleural effusion or pleural deposits. Hyperthermic intraperitoneal
chemotherapy (HIPEC) is added to the treatment plan in cases of complete CRS but this is a technically
demanding procedure. Therefore, performing hyperthermic intrathoracic chemotherapy on top of CRS and HIPEC
may be even more complicated for such advanced cancers. The technique of combining HIPEC and hyperthermic
intrathoracic chemotherapy is also commonly known as hyperthermic thoracoabdominal chemotherapy (HITAC).
The perioperative morbidity and mortality may be remarkably high in such scenarios. We describe our CRS
technique with HITAC, which was performed in three FIGO stage IVA ovarian carcinoma patients with metastatic
pleural effusion after complete CRS. The patients were retrospectively identified from a prospectively maintained
database. All had partial diaphragmatic resection followed by HITAC as part of CRS treatment. Surgical techniques

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