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Abstract
Introduction 2Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy
Complete disease removal during cytoreductive surgery for AEOC is the main prognostic factor for both PDS and IDS. While a unanimous consensus exists on the RT=0 during PDS, the same is not true for IDS. Many surgeons do not consider necessary the removal of macroscopically normal or with apparent scarring areas peritoneum.
This study aims to establish whether the intraoperative visual assessment can be a sufficiently sensitive tool to identify the presence or absence of residual disease.
Methods Observational retrospective study. Pre-operative, surgical and histopathological features of patients subjected to IDS with visually-suspected (figure 1) or certain (figure 2) residual disease at the level of the right diaphragmatic peritoneum, have been collected.
Results The study included 155 patients, with 92 patients classified as patients with ‘Visually-Pathologic diaphragmatic peritoneum’ (group-1) and 63 as patients with Visually-Suspected diaphragmatic peritoneum’(group-2).
In group-1, all diaphragmatic specimens resulted positive, while group-2 showed 19% of patients with negative histological results and 81% with positive specimens.
Visual examination showed a sensitivity of 64.3% and a specificity of 100%. PPV has been of 100% while NPV has been of 19%. Accuracy was of 67% (k=0.218).
Frozen section evaluation was applied in 28 cases, and showed an accuracy of 92.6% (k=0.700).
Conclusions Visually suspected areas often hide micro-macroscopic residual disease after chemotherapy. Frozen section of suspicious areas could be the key to perform a patient tailored surgery.