Department of Surgical Oncology, Zydus Hospital, Thaltej, Ahmedabad, 380054, India.
Department of Surgical Oncology, Saifee Hospital, Mumbai, India.
Ann Surg Oncol. 2021 Feb;28(2):1118-1129. doi: 10.1245/s10434-020-08918-4. Epub 2020 Aug 3.
Total parietal peritonectomy (TPP) removes areas of "normal-appearing" parietal peritoneum bearing microscopic residual disease and has the potential to improve survival of patients undergoing interval cytoreductive surgery (CRS) for advanced serous epithelial ovarian cancer. This report presents the morbidity outcomes for the first 50 patients enrolled in TORPEDO (CTRI/2018/12/016789), a prospective study.
All the patients underwent a TPP during interval CRS. A surgical protocol that includes a description of the boundaries for each of the five peritonectomies was followed. The common toxicology criteria for adverse events (CTCAE) classification was used to record 90-day morbidity and mortality.
The median Peritoneal Cancer Index (PCI) for 50 patients was 15 (range, 5-37). A complete cytoreduction (CC-0 resection) was obtained in 80%, a CC-1 resection in 16%. A bowel resection was performed in 70% of the patients. Grade 3 or 4 complications were seen in 11 patients (22%), and one patient died within 90 days after surgery due to intraperitoneal hemorrhage. The most common complications were postoperative fluid collection requiring aspiration (n = 5), intraperitoneal hemorrhage (n = 2), abdominal wound dehiscence (n = 2), pseudo-obstruction (n = 1), urinary sepsis (n = 2), and ileostomy-related complications (n = 2). No bowel fistulas or anastomotic leaks occurred. Microscopic disease in 'normal appearing' peritoneum adjacent to tumor nodules was observed in 46% of the patients, and in regions given a lesion score of 0 in 34%. The parietal peritoneal regions (0-8) had a higher incidence of residual disease (p < 0.001) and occult disease (p < 0.001).
During interval CRS, TPP can be performed with acceptable morbidity and mortality. The pathologic findings further support this therapeutic rationale. Survival outcomes should determine the future role of such a procedure in routine clinical practice.
全壁层腹膜切除术（TPP）切除了带有微观残留疾病的“正常外观”壁层腹膜区域，有可能提高接受间隔细胞减灭术（CRS）治疗晚期浆液性上皮性卵巢癌患者的生存率。本报告介绍了 TORPEDO（CTRI/2018/12/016789，前瞻性研究）中前 50 名入组患者的发病率结果。
所有患者均在间隔 CRS 期间接受 TPP。遵循了一项包括描述五个腹膜切除术的每个边界的手术方案。使用常见的不良事件毒性标准（CTCAE）分类记录 90 天的发病率和死亡率。
50 名患者的中位腹膜癌指数（PCI）为 15（范围 5-37）。80%的患者获得完全肿瘤细胞减灭术（CC-0 切除），16%的患者获得 CC-1 切除。70%的患者行肠切除术。11 名患者（22%）出现 3 级或 4 级并发症，1 名患者术后 90 天因腹腔内出血死亡。最常见的并发症是需要抽吸的术后积液（n=5）、腹腔内出血（n=2）、腹部伤口裂开（n=2）、假性梗阻（n=1）、尿脓毒症（n=2）和回肠造口术相关并发症（n=2）。没有发生肠瘘或吻合口漏。在肿瘤结节相邻的“正常外观”腹膜上观察到 46%的患者存在显微镜下疾病，在病变评分 0 的区域观察到 34%的患者存在显微镜下疾病。壁层腹膜区域（0-8）残留疾病（p<0.001）和隐匿性疾病（p<0.001）的发生率更高。
在间隔 CRS 期间，TPP 可在可接受的发病率和死亡率下进行。病理发现进一步支持了这种治疗的合理性。生存结果应确定这种手术在常规临床实践中的未来作用。
