Comparative oncological efficacy of chemotherapy, cytoreductive surgery with or without HIPEC in recurrent ovarian cancer: A network meta-analysis
In brief
Secondary surgery with or without HIPEC extends progression-free survival by about 25% in recurrent ovarian cancer
A network meta-analysis of 1,831 patients showed that both secondary cytoreductive surgery alone and surgery plus HIPEC lengthened five-year progression-free survival by roughly one-quarter compared with chemotherapy, while overall survival was unchanged overall. Benefit appeared strongest in patients with complete tumor removal, and the survival advantage of adding HIPEC remains uncertain and based on indirect evidence.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 11 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Richard Sassun, Shigeki Kusamura, Dario Carlo Angelo Baratti, Marcello Guaglio, Gaia Colletti, Francesca Laura Nava, et al.
- PMID
- 42748584
- DOI
- 10.1016/j.ejso.2026.112125
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 20 September 2026): High-quality evidence in a top journal
- Picked for Gastrointestinal and Colorectal Surgery (top studies of the week, 20 September 2026): Chemotherapy vs surgery in recurrent ovarian cancer
- Picked for Radiation Oncology (top studies of the week, 20 September 2026): Recent Radiation Oncology research from a high-quartile journal
- Picked for Surgical Oncology (paper of the day, 17 September 2026): Network meta‑analysis of surgery ± HIPEC vs chemotherapy
Abstract
BACKGROUND: The role of secondary cytoreductive surgery (SCS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in platinum-sensitive recurrent ovarian cancer remains challenging. While chemotherapy (CHT) remains the standard approach, interest has grown in SCS, either with or without HIPEC. Despite promising results, the comparative effectiveness of SCS, SCS + HIPEC, and chemotherapy alone remains controversial, with no trials directly comparing SCS + HIPEC with CHT alone. METHODS: This systematic review and network meta-analysis included five randomized controlled trials (GOG-0213, DESKTOP III, SOC-1, CHIPOR, and HORSE) identified through PubMed, Embase, Scopus, and Cochrane. The analysis encompassed 1831 patients. A frequentist random-effects network meta-analysis was performed, with CHT as the reference. Heterogeneity was quantified using I2. RESULTS: Neither SCS (HR 0.97, 95% CI 0.80-1.19) nor SCS + HIPEC (HR 0.76, 95% CI 0.54-1.08) significantly improved 5-year OS compared to CHT alone (I2 = 68.4%). Both interventions significantly prolonged 5-year PFS (SCS HR 0.75, 95% CI 0.63-0.88; SCS + HIPEC HR 0.71, 95% CI 0.53-0.94, I2 = 13.8%). When excluding GOG-0213, SCS + HIPEC significantly improved OS (HR 0.65, 95% CI 0.44-0.94, p = 0.023, I2 = 0%). For CC-0 patients, SCS + HIPEC and SCS improved both OS and PFS compared to CHT. For CC-1 patients, SCS + HIPEC may be associated with improved OS and PFS, whereas SCS alone may be associated with worse OS. CONCLUSIONS: SCS with or without HIPEC is associated with increased PFS and may also increase OS in certain scenarios. The comparison of SCS + HIPEC versus CHT rests on indirect evidence and possible bias given that CHIPOR trial used neoadjuvant chemotherapy. The apparent benefit of SCS + HIPEC in CC-1 patients remain exploratory.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.