Total parietal peritonectomy performed during interval cytoreductive surgery for advanced epithelial serous ovarian cancer results in a low incidence of platinum resistant recurrence - results of a prospective multi-centre study
Menée sur la période 2018-2019 auprès de 70 patientes atteintes d'un carcinome séreux de l'ovaire (durée médiane de suivi : 13 mois), cette étude multicentrique analyse l'incidence d'une récidive résistante aux sels de platine après une péritonectomie pariétale réalisée pendant une chirurgie de réduction tumorale d'intervalle
Background and Aim: The reported incidence of platinum resistant recurrence(PRR) (recurrence within 6 months of the last dose of platinum therapy) after interval debulking/cytoreductive surgery (CRS) is high compared to that after primary CRS. The goal was to study PRR following a total parietal peritonectomy (TPP), that addresses occult disease more completely. Methods: This is a prospective multi-center study (CTRI/2018/08/015350). A TPP was performed during interval CRS following a fixed surgical protocol. Patients with a follow-up of 6 months(M) or more were included in this analysis. The incidence and patterns of PRR and factors affecting recurrence were analyzed. Results: From July 2018 to October 2019, 70 patients with serous carcinoma were included. The median surgical PCI was 15 [range 5–37]. A CC-0 resection was obtained in 55(78.5%); CC-1 in 10(14.2%). Occult residual disease was seen in 40%. At a median follow-up of 13months, 17(24.2%) had developed recurrence/progression. PRR was seen in 5(7.1%) patients. The sites of progression (>1 in 2 patients) were pleura (n = 1), visceral peritoneum(n = 2), retroperitoneal nodes(n = 2), mediastinal nodes(n = 1) and small bowel mesentery(n = 2). Overall, though the most common site of recurrence was the visceral peritoneum(N = 9), seven (>40%) patients did not develop recurrence in the visceral peritoneum. Patients with high PCI and grade 3–4 complications had a higher probability of developing recurrence. Conclusions: TPP performed during interval CRS resulted in a very low incidence of PRR. These findings need confirmation in a larger series. The benefit of TPP over conventional surgery should be evaluated in a randomized trial.