Peritoneal dissemination and extent of peritonectomy in advanced epithelial ovarian cancer

We reviewed the current literature regarding patterns of peritoneal dissemination and extent of peritoneal resection that should be performed in patients with advanced epithelial ovarian cancer (EOC). The preliminary results of our prospective study evaluating the role of total parietal peritonectomy (TPP) and wide resection of the visceral peritoneum performed during interval cytoreductive surgery (CRS) are presented and discussed. Studies on peritoneal spread and response to systemic chemotherapy in EOC show that the incidence of occult disease is high in the peritoneum that appears ‘normal’ during surgery and is likely to be the source of recurrent disease. Hyperthermic intraperitoneal chemotherapy (HIPEC) acts on microscopic disease as well as free intraperitoneal cancer cells shed during surgery, thus, reducing the risk of recurrence. The addition of HIPEC to interval CRS showed a benefit in both progression-free and overall survival over interval CRS alone. The only definitive way to eradicate such occult disease completely is resection of the peritoneum. And thus, a TPP performed along with wide resection of the visceral peritoneum may be a more effective strategy for addressing this occult disease compared to other locoregional therapies like HIPEC and systemic therapies. The postoperative complications was acceptable. Both progression-free and overall survival are improved after TPP. The incidence of platinum resistance recurrence was much lower than previous reports.