Total Infragastric Omentectomy Including the Vascular Perigastric Arcade in Patients With Advanced Serous Ovarian Tumors

Vidal, Gloria Cordeiro; Croce, Sabrina; Guyon, Frédéric; Babin, Guillaume; Querleu, Denis

doi:10.1097/igc.0000000000000832

Cited by 5 publications

(12 citation statements)

References 40 publications

(24 reference statements)

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“…Twelve out of 33 of our group 1 patients were positive for metastasis in the PGA, amounting to 36.4%. While, the study by Cordeiro Vidal et al [ 10 ] showed a positivity of 62.5%. This disparity can be explained by the fact that they undertook a more rigorous sectioning and examination of the PGA specimen to look in detail for microscopic metastasis.…”

Section: Discussionmentioning

confidence: 94%

“…Literature on this particular aspect is sparse. A remarkable study done by Cordeiro Vidal et al [ 10 ] has served as the benchmark for us.…”

Section: Discussionmentioning

confidence: 99%

“…Removal of perigastric arcade (PGA) of the omentum is one of the controversial aspects of omentectomy in view of its proximity to the stomach and hence the fear of injury, vascular compromise and gastroparesis. Cordeiro Vidal et al [ 10 ] in their study found microscopic involvement of the PGA in advanced epithelial ovarian cancer (AEOC) in 62.5% of the cases. But, the implications of this procedure on intra and postoperative complications have not been addressed adequately [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cordeiro Vidal et al [ 10 ] in their study found microscopic involvement of the PGA in advanced epithelial ovarian cancer (AEOC) in 62.5% of the cases. But, the implications of this procedure on intra and postoperative complications have not been addressed adequately [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Role of perigastric arcade removal in serous epithelial ovarian cancers

Kulkarni¹,

Mohapatra²,

Nayak³

et al. 2023

ecancer

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Introduction Omentectomy is an essential part of cytoreductive surgery (CRS). However, removal of perigastric arcade (PGA) of the omentum is a controversial aspect of omentectomy in view of the fear of injury, vascular compromise and gastroparesis. Hence, we conducted a study to evaluate the necessity and effect of removal of PGA during omentectomy. Methods The nature of the study was a prospective observational study. The study period was for 1 year between 1.3.2019 and 29.2.2020. Patients with stage III to IV serous epithelial ovarian cancers – chemo naive/post neoadjuvant chemotherapy, without macroscopic involvement of the PGA were included in the study. Patients were divided into two groups – those who had PGA removed (group 1) and those whose PGA was preserved (group 2). Pre, intra and postoperative factors between the two groups were compared using standard statistical methods. Results Micrometastasis to PGA was present in 36.4% of the patients in group 1. The predictors for this involvement included gross involvement and microscopic involvement of the mobile part of the omentum ( p < 0.001), pre surgery Meyer’s score ( p < 0.05) and requirement of peritonectomy ( p < 0.05) during the CRS implying that higher the peritoneal carcinomatosis, more are the chances of microscopic involvement of PGA. On comparing postoperative outcomes between the two groups, we noted a statistically significant difference in intra-operative time ( p < 0.01), prolonged recovery time with increased intensive care unit and hospital stay ( p < 0.001) in group 1, although all with small absolute difference. However, there was no significant difference in major post-operative complications or time taken to tolerate soft diet. Conclusion Micrometastasis to PGA was noted in significant number of cases. Its removal is also a safe procedure with minimal morbidity and good postoperative outcomes especially in cases with significant peritoneal carcinomatosis. Hence, it should be considered, provided we are achieving a complete cytoreduction otherwise.

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Section: Discussionmentioning

confidence: 94%

“…Literature on this particular aspect is sparse. A remarkable study done by Cordeiro Vidal et al [ 10 ] has served as the benchmark for us.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Role of perigastric arcade removal in serous epithelial ovarian cancers

Kulkarni¹,

Mohapatra²,

Nayak³

et al. 2023

ecancer

View full text Add to dashboard Cite

show abstract

“…Furthermore, when macroscopic omental metastasis is not apparent, subtotal omentectomy (infracolic omentectomy) is often performed. In such cases, some adipose tissue at omentum remains and, in fact, the unresected supracolic omentual region has been reported to be the frequent site of subclinical metastasis when specimens from total omentectomy were evaluated [42]. Therefore, it can be reasonably assumed that a considerable amount of adipocytes still exist in the tumor microenvironment of stealth OvCa cells even after surgical resection of the greater omentum.…”

Section: Discussionmentioning

confidence: 99%

Obesity contributes to the stealth peritoneal dissemination of ovarian cancer: a multi‐institutional retrospective cohort study

Iyoshi

Sumi

Yoshihara

et al. 2022

Obesity

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Objective The clinical significance of a higher BMI on the prognosis of ovarian cancer remains controversial; therefore, a more detailed analysis is demanded. This study investigated the impact of BMI on peritoneum‐specific recurrence to clarify the involvement of adipose tissue in the proliferation of cancer cells at sites of peritoneal dissemination. Methods Among 4,730 patients with malignant ovarian tumors, 280 diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IIIC epithelial ovarian cancer and who underwent complete resection in the primary surgery were included in the present study. Results There were 42, 201, and 37 women in the low, normal, and high BMI groups, respectively. Peritoneum‐specific recurrence‐free survival and overall survival were both significantly shorter in patients with a high BMI than in those with a normal BMI (p = 0.028 and 0.018, respectively). No significant differences were observed in the distribution of sites of recurrence between these two groups. A multivariate analysis identified obesity as an independent prognostic factor in addition to pT3 tumor staging and positive ascites cytology. Conclusions Patients with a high BMI had a significantly worse prognosis than those with a normal BMI, and peritoneal adipose tissue may have contributed to this difference.

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Is routine omentectomy of grossly normal omentum helpful in surgery for ovarian cancer? A look at the tumor microenvironment and its clinical implications

Bilbao

Ostrovsky

2021

Gynecologic Oncology

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Total Infragastric Omentectomy Including the Vascular Perigastric Arcade in Patients With Advanced Serous Ovarian Tumors

Abstract: In this study, evidence is given that total omentectomy including the perigastric area is a necessary component of complete cytoreductive surgery in advanced ovarian cancer, whatever the macroscopic appearance of the omentum.

Cited by 5 publications

References 40 publications

Role of perigastric arcade removal in serous epithelial ovarian cancers

Role of perigastric arcade removal in serous epithelial ovarian cancers

Obesity contributes to the stealth peritoneal dissemination of ovarian cancer: a multi‐institutional retrospective cohort study

Is routine omentectomy of grossly normal omentum helpful in surgery for ovarian cancer? A look at the tumor microenvironment and its clinical implications

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