Extent and distribution of peritoneal disease in patients undergoing cytoreductive surgery for first platinum sensitive recurrence in ovarian cancer and its potential therapeutic implications. Issue 12 (December 2020)

• Record Type: Journal Article
• Authors: Bhatt, Aditi; Bakrin, Naoual; Gertych, Witold; Kammar, Praveen; Parikh, Loma; Sheth, Sandeep; Shaikh, Sakina; Devouassoux-Shisheboran, Mojgan; Glehen, Olivier
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 12(2020)
• Page Start: 2276
• Page End: 2282
• Publication Date: 2020-12
• Subjects: Platinum sensitive recurrent ovarian cancer -- Cytoreductive surgery -- Peritoneal disease distribution -- Lymph node involvement -- Pathological PCI; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.05.029
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Selected patients with platinum sensitive recurrent ovarian cancer may benefit from cytoreductive surgery (CRS). The aim was to study the pattern of peritoneal involvement in these patients that has not been done before. Methods: A comparison was made between the surgical and pathological findings in 60 patients undergoing salvage CRS from July 2018 to December 2019. The sites of residual disease, correlation with surgical and pathological peritoneal cancer index (PCI), small bowel involvement and regional lymph node involvement were studied. Results: Fifty-eight (96.6%) had serous carcinoma and 2 (3.4%) clear cell carcinoma. The median surgical PCI (sPCI) was 7 [range 0–27] and median pathological PCI (pPCI) 4 [range 0–21]. CC-0 resection was performed in 81.6%. The upper regions (region 1, 2, 3) were the commonest sites of residual disease (63.3%) followed by lower regions (region 5, 6, 7) in 55.0%, middle regions (regions 0, 4, 8) in 53.3% and small bowel regions (regions 9–12) in 26.6%. Small bowel involvement was associated with a higher sPCI and pPCI (p < 0.001 for both). Regional nodes were involved in 46.6%. A pathological complete response was seen in 8 (13.3%) patients of which 2 had residual disease in regional nodes. Microscopic disease in 'normal appearing' peritoneum was seen in 21%. Conclusions: The parietal peritoneum was the commonest site of recurrence. Small bowel involvement occurred late and was associated with more extensive disease. Regional lymph node involvement was seen nearly 50% and was a common site for occult disease. The role of more extensive parietal peritoneal resection for recurrent disease should be evaluated prospectively. Highlights: The parietal peritoneum is the most common site of residual disease Microscopic disease in 'normal appearing' peritoneum is seen in 21% Regional lymph node involvement is seen in 50% undergoing CRS for recurrence Small bowel involvement is seen in patients with a high PCI Pathological complete response to second line chemotherapy is seen in 13.3%