Management of pleural disease in advanced ovarian malignancy by excision of gross pleural deposits, pleurectomy, and excision of mediastinal and diaphragmatic nodes along with abdominal disease debulking can be done with a multispeciality approach. The addition of hyperthermic intrathoracic chemotherapy (HITHOC) to the surgical debulking and hyperthermic intraperitoneal chemotherapy (HIPEC) known as hyperthermic intraoperative thoracoabdominal chemotherapy (HITAC) is a novel procedure. The primary objective of this study was to assess the feasibility of the addition of HITHOC to the HIPEC procedure during interval debulking surgery (IDS) in cases of stage IV epithelial ovarian carcinoma.

After performing optimal abdominopelvic cytoreduction, the pleural cavity was assessed by thoracoscopy, and surgical cytoreduction was done in the chest. A continuum in the thoracic and abdominal cavity was maintained via diaphragmatic incision followed by instillation of heated intracavity chemotherapy.

A total of eight patients were included over a period of one year (August 2022–July 2023). Complete gross resection of disease was achieved in abdominal as well as thoracic cavity in all patients. Median blood loss was 600 ml. Three patients were transfused 2 units blood, and four patients were transfused one unit blood each. No grade 3 or more complications (CTCAE) were noted. Median follow-up was 14.6 months. Single recurrence was noted at 5.5 months after completion of adjuvant chemotherapy. Patient progressed on chemotherapy and succumbed to the disease. Longest follow-up was 20 months.

After an optimal debulking is done in stage IV ovarian carcinoma in the abdominopelvic cavity, VATS followed by debulking of chest disease and addition of HITHOC to the hyperthermic intraperitoneal chemotherapy (HIPEC) procedure is feasible without any additional morbidity.