Efficacy and safety of secondary cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in platinum-sensitive recurrent ovarian cancer: a systematic review and meta-analysis.

OBJECTIVE: This study aims to compare the efficacy and safety of secondary cytoreductive surgery (SCS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) versus SCS alone in the management of platinum-sensitive recurrent ovarian cancer (PSROC) through a systematic review and meta-analysis. METHODS: A comprehensive search was performed in the PubMed, EMBASE, Web of Science, and Cochrane Library databases through December 31, 2024. Studies were eligible if they compared outcomes between individuals receiving SCS combined with HIPEC and those receiving SCS alone. The primary outcomes included progression-free survival (PFS) and overall survival (OS), measured using hazard ratios (HRs) with 95% confidence intervals (CIs). Secondary outcomes included the incidence of complications, reported as relative risks (RRs) with 95% CIs. Statistical analyses were conducted using Stata software (version 15.1). RESULTS: A total of seven studies comprising 1,136 patients were included. Of these, 563 patients underwent SCS combined with HIPEC, while 573 received SCS alone. The pooled analysis indicated that the addition of HIPEC to SCS was associated with a significant improvement in OS (HR = 0.76, 95% CI [0.62, 0.94], p = 0.01). However, no statistically significant improvement was observed in PFS (HR = 0.91, 95% CI [0.72, 1.15], p = 0.43). The overall incidence of grade ≥ 3 complications did not differ significantly between the two groups (RR = 1.42, 95% CI [1.00, 2.01], p = 0.05). Nonetheless, the incidence of nephrotoxicity (RR = 1.71, 95% CI [1.20, 2.43]) and anemia (RR = 1.38, 95% CI [1.18, 1.62]) was higher in the group treated with SCS and HIPEC. No significant difference was noted in the incidence of thrombocytopenia (RR = 1.41, 95% CI [0.76, 2.59]). CONCLUSION: The integration of HIPEC with SCS may improve OS among patients with PSROC without a marked increase in severe complications; however, increased risks of nephrotoxicity and anemia should be considered in clinical decision-making. Further standardization of HIPEC protocols and the implementation of large-scale randomized controlled trials are recommended to confirm these findings and establish definitive clinical guidelines.