AbstractIntroductionResidual disease in ‘normal appearing’ peritoneum is seen in nearly 30% following neoadjuvant chemotherapy for advanced epithelial ovarian cancer. Our goal was to study prospectively, the sequence of response in different regions, the commonest sites of occult residual disease, its incidence in different peritoneal regions and the potential therapeutic implications of these.MethodsThe patterns of response were studied based on the finding of residual disease in cytoreductive surgery specimens on pathological evaluation. A protocol for pathological evaluation was laid down and followed. Informed consent was taken from all patients. A correlation between clinical and pathological findings was made. Sugarbaker’s peritoneal cancer index was used to describe the regional distribution of peritoneal diseaseResultsIn 85 patients treated between July 2018 to June 2019, 83 FIGO stage III-C at diagnosis and 2 stage IV-A. Microscopic disease in ‘normal appearing’ peritoneal regions was seen in 22 (25.2%) and in normal peritoneum around tumor nodules in 30 (35.2%). Regions 4 and 8 of Sugarbaker’s peritoneal cancer index had the highest incidence of residual disease in absence of visible disease and regions 9 and 10 the lowest. The response to chemotherapy occurred in a similar manner in over 95% of the patients-the least common site of residual disease was the small bowel mesentery, followed by upper regions (regions 1-3), omentum and middle regions (regions 0, 4, 8), lower regions (regions 5-7) and lastly the ovaries. Nearly 85% had 4 or more peritonectomies and 67% had 6-7 peritonecomies.ConclusionsComplete resection of involved the peritoneal region could address all the occult disease in a particular region. The role of resection of the entire region as well as ‘normal appearing’ parietal peritoneal regions (or total parietal peritonectomy) during interval cytoreduction should be prospectively evaluated to determine its impact on morbidity and survival.
155 Prognostic value and therapeutic implications of pleural carcinosis and malignant pleural effusion in advanced epithelial ovarian cancer
