Role of perigastric arcade removal in serous epithelial ovarian cancers

Introduction: Omentectomy is an essential part of cytoreductive surgery (CRS). However, removal of perigastric arcade (PGA) of the omentum is a controversial aspect of omen-tectomy 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 omen-tectomy.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 epi-thelial ovarian cancers - chemo naive/post neoadjuvant chemotherapy, without macro-scopic 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 espe-cially in cases with significant peritoneal carcinomatosis. Hence, it should be considered, provided we are achieving a complete cytoreduction otherwise.