Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

Abstract

Objective: This study aimed to evaluate the presence of pathological residual tumor (pRT) in each initial disseminated site after neoadjuvant chemotherapy (NACT) to assess the appropriate surgical margins during interval debulking surgery (IDS) for a favorable prognosis. Methods: This prospective descriptive study included patients with stage IIIC-IV epithelial ovarian, fallopian tubal, and peritoneal cancer. One hundred eleven patients underwent diagnostic exploratory laparotomy, and their initial intra-abdominal dissemination statuses were recorded. Any tumor >1 cm in diameter found during the exploratory laparotomy was resected during IDS even if it was macroscopically invisible after NACT. The pRT rate after NACT and negative predictive value (NPV; probability that sites with macroscopically invisible tumors have no pRT) during IDS were assessed in each disseminated site. Results: A median of 5 NACT cycles were performed. Sites with a high incidence of pRT and low NPV included the rectosigmoid colon (71.4%, 38.6%), transverse mesentery (70.3%, 50.0%), greater omentum (68.3%, 51.7%), right diaphragm (61.9%, 48.1%), paracolic gutters (61.1%, 50.0%), and vesicouterine pouch (56.6%, 50.0%). Organs/tissues with a high incidence of pRT featured a low NPV. The median progression-free survival and overall survival in this cohort were 27.7 and 71.9 months, respectively. Conclusion: Even if a disseminated site >1 cm in diameter before NACT is invisible during IDS, microscopic disease remains present within it. The appropriate surgical margins for IDS with a favorable prognosis could be secured by resecting a lesion of >1 cm before NACT even if it is invisible during IDS.

Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Epithelial Ovarian Cancer: A 20-Year Single-Center Experience

“…Because of the different regimens (drug, timing, duration, temperature) and the heterogeneity of populations (residual tumor, histology, stage) among investigations, there is controversy surrounding which patients can benefit from HIPEC. In agreement with most authors, we believe that HIPEC should not be considered an independent treatment modality, but as a complementary modality to systemic chemotherapy and novel targeted therapies [ 6 , 7 , 8 , 9 , 10 , 29 , 30 , 31 , 35 , 36 , 37 , 44 ].…”

“…Intraoperative estimation of PCI is currently considered the gold standard for evaluating the extent of disease, but cytoreduction may be underrated after NACT, since it alters the morphology of peritoneal deposits, making it difficult to evaluate the extent of dissemination. A high incidence of occult microscopic disease in normal-looking areas of peritoneum and scar tissues occur, which may be left inside in up to half of the cases [ 34 , 36 ]. The complete removal of parietal peritoneum and “target regions” should always be performed, regardless of the presence of visible disease.…”

Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer

“…The quality of CRS remains a decisive element in the management of patients. The presence of mPM after NACT could be related to visible metastases prior to chemotherapy, as suggested by the publication of Tate et al [ 41 ], encouraging the surgeon to note locations of metastases at the initial exploratory laparoscopy to resect these locations in case of doubt at the time of interval CRS. Given the limitations of this study, which concerns a cohort with a limited number of patients ( n = 26), the absence of a separate analysis of patients who have or not received NACT and the mathematical method that involves the use of hypotheses that induce limits in its interpretation, other studies would be expected to reinforce our findings.…”

Surgical Techniques and Outcomes of Colorectal Anastomosis after Left Hemicolectomy with Low Anterior Rectal Resection for Advanced Ovarian Cancer

“…The surgical policy and chemotherapeutic regimen used during the study period were described in a previous report [15][16][17]. A monodisciplinary surgical team consisting of three gynecologic oncologists with expertise in advanced ovarian cancer treatment performed cytoreductive surgery, including colonic resection, to achieve complete cytoreduction.…”