**Abstract**

This chapter is dedicated to cytoreductive procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of advanced ovarian cancer. Cytoreductive procedures and HIPEC constitute nowadays an important weapon in the surgical armamentarium used to treat ovarian cancer. Our service led by Dr. Moldovan Bogdan has an experience of 235 patients that underwent a HIPEC procedure, with an average of 33,5 cases/year which places us among some of the most experienced teams worldwide. We propose a chapter describing the indications and contraindications of such procedures, the surgical approach, followed by a description of our experience, including a review of our indications, the type of chemotherapeutic agents and a case example.

**Keywords:** cytoreductive surgery, HIPEC, carcinomatosis, hyperthermic intraperitoneal chemotherapy, cisplatin, doxorubicin

### **1. Introduction**

Ovarian cancer ranks as the seventh most common cancer in women worldwide, as shown by a metanalysis of 125 articles published between 1925 and 2018 [1]. This frequency also comes with a non-neglectable mortality which in the same meta-analysis is estimated at 4,4% of all the cancer cases, in 2018. The mortality index is mostly due to the fact that the diagnosis is made when the disease is already advanced with two thirds of the mortality being attributed to advanced forms of serous carcinoma. Even with the current care recommendations which involve standard cytoreductive surgery and multiple lines of chemotherapy the confounded long-term survival for all disease stages is only 20–30% and is mostly due to peritoneal carcinomatosis [1–6]. As such we find that completing the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the best way to ensure the best possible outcomes for ovarian cancer patients. A review of the current literature shows that it improves the 5-year survival to 24–60% compared to an average life expectancy of 12 to 25 months with standard chemotherapy [4, 7].

The aim of this chapter is to bring insight into our current surgical practice of performing extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
