ASO Author Reflections: Total Parietal Peritonectomy During Interval Cytoreductive Surgery for Advanced Ovarian Cancer—Proof-of-Principle and Analysis of Morbidity

Excerpt

Recurrence after first-line therapy for advanced ovarian cancer occurs in more than 80% of patients. More specifically, for surgery performed after neoadjuvant chemotherapy (NACT), the reported rates of early recurrence are higher and the overall survival inferior in some reports. Several studies have demonstrated a high incidence of occult disease in “normal” or benign-appearing areas of the peritoneum after NACT.1,2 Although the parietal peritoneum constitutes only 20% of the total peritoneal surface area, 80% of the tumor spread is in this region and may be attributed to a greater concentration of lymphatics. Conventionally, interval cytoreductive surgery is performed with the goal of resecting the sites of residual disease alone and the parietal peritoneal resection performed can be termed as selective parietal peritonectomy (SPP). Complete removal of the parietal peritoneum (total parietal peritonectomy [TPP]) has the oncological benefit of removing a large proportion of the occult disease. Secondly, areas of response are known to harbor chemotherapy resistant stem cells, and TPP can remove these areas effectively.3 …