Objectives The aim of this study was to assess the morbidity & mortality, recurrence pattern & oncological outcomes of extent of parietal peritonectomy done during CRS & HIPEC for advanced ovarian cancer.

Methods Patients diagnosed with stage IIIc epithelial carcinoma ovary underwent selective parietal peritonectomy (SPP) or complete parietal peritonectomy (CPP) with CRS–HIPEC. All peri operative data were analysed with focus on morbidity, mortality, recurrence pattern and oncological outcomes.

Results Of 110 cases,20, 55 & 35 were upfront, interval & secondary cancers respectively. 50 & 60 patients underwent CPP & SPP respectively. TPP group had longer duration of surgery (10.7 vs 8.9), more blood loss (1062 vs 655 ml) increased hospital stay (16 vs 11). Number of diaphragmatic resections, bowel resections, anastomosis and stoma were comparable but TPP group required more multivisceral resections. Overall G3-G5 morbidity was TPP 55% vs SPP 30%. TPP group had increased pulmonary complications, intra-pleural & intra-abdominal collections. With a median follow up of 35 months DFS was 33 vs 25 months for TPP & IPP group respectively however median OS was yet to be achieved in both group. 25 out of 70 patients (35.7%) had presence of disease on pathological assesment which was normal looking on visual assesment.

Conclusions Patients who underwent TPP had decreased peritoneal & overall recurrence translating to significantly higher DFS & trend towards improved OS. Aggressive CRS benefits patient with manageable morbidity. However, longer follow-up and a prospective multi-institutional randomized study need to be designed for more evidence of the same.