TITLE:
Total Peritoneal Gutter Removal versus Random Peritoneal Biopsy in Cases of Ovarian Cancer
AUTHORS:
Ahmed Abdel-Azeem Essmat, Mahmoud El-Sayed Meleis, Helmy Abdel-Sattar Rady, Inass Ibrahim Ahmed Zaki, Ahmed Shaaban Ali Ragab Khattab
KEYWORDS:
Pelvic Peritonectomy, Gutter Resection, Ovarian Cancer
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.10,
October
19,
2021
ABSTRACT: Introduction: Ovarian cancer is the fourth most prevalent cancer
among women and the seventh most common cancer overall.
Every year, an estimated 200,000 cases and 125,000 deaths related to ovarian
cancer are reported around the world. It is most common in high-resource
countries, with an incidence rate of 9.3 per 100,000 women. Ovarian
cancer is detected at an advanced stage in about 70% of instances, and only 30%
of women with such cancers live for more than 5 years. Although only around 20%
of ovarian cancers are limited to the ovaries at diagnosis, patients with
localized disease have a 5-year survival rate of more than 90%. Peritonectomy
is a crucial part of the surgical treatment for ovarian cancer. Visual
inspection and palpation are not reliable methods for determining the extent of
tumour involvement. The majority of gynecologic oncologists are suspicious
about the benefits of a full peritonectomy, concerned about the benefits and
hazards. They believe that the tumor’s fundamental biology, not surgical
aggressiveness, dictates the tumor’s resectability. The aim of this work was
primarily to compare the differences between total peritoneal gutter removal
and random peritoneal biopsy in cases of early ovarian cancer. A secondary aim
of this work is to show ability of total peritoneal gutter removal in relation
to that of random peritoneal biopsy to detect positivity of metastasis in the
histopathological specimens. Patients and Methods: This prospective
cohort study was conducted on 130 patients with early ovarian cancer in
El-Shatby hospital, Faculty of Medicine, Alexandria University. For each
patient, we took random and total peritoneal biopsy and compared between them
regarding technique, timing, post-operative complications, and
histopathological results. Inclusion criteria: all age group, suspected
ovarian cancer using IOTA score, absence of nodules in the peritoneal gutter
using CT and any case that needs staging laparotomy for ovarian cancer. Exclusion
criteria: presence of gross peritoneal disease in the gutter and CT features of advanced ovarian
cancer (peritoneal deposits, omental
cakes, pelvic and para-aortic lymphadenopathy). All cases will be subjected to the followings: history taking, clinical examination, suspicious
ovarian mass using IOTA score, tumor markers, CT staging, staging laparotomy
and random and total peritoneal biopsies will be collected from the same case
and sent to the lab of pathology for histopathological examination and the
results will be compred regarding positivity of metastasis. Results: Random
peritoneal biopsy showed positive metastasis in 6 (4.6%) cases and free in 124
(95.4%) cases while total peritoneal gutter removal showed positive metastasis in 19 (14.6%) cases and free in 111 (85.4%) with
Chi-square test was 7.479 and P value was 0.004 which is statistically
significant. 108 (97.3%) cases had negative random peritoneal biopsy and
negative total peritoneal gutter removal, 3 (2.7%) cases had positive random
peritoneal biopsy and negative total peritoneal gutter removal, 16 (84.2%)
cases had positive total peritoneal gutter removal and negative random
peritoneal biopsy & 3 (15.8%) cases had positive total peritoneal gutter
removal and positive random peritoneal biopsy with Chi-square test 6.311, FEp
0.04 and Kappa test 0.183 (0.012) which is statistically significant with poor
strength of agreement. Conclusions: Modified total peritoneal gutter
removal is a safe, fast and easy technique compared
to random peritoneal biopsy and even to traditional peritonectomy procedure with high detection rates of peritoneal involvement with sensitivity
of 50% and specificity of 87.5% and it is recommended to be done as a routine
alternative to random peritoneal biopsy and even to traditional total gutter
removal in all cases of ovarian malignancies for diagnostic and therapeutic
values.