Introduction/Background Among gynaecologic cancers, ovarian cancer often metastasizes and forms implant tumors via peritoneal circulation. Definitive surgical staging is essential for optimal therapy in clinical early-stage disease.It is uncertain whether peritoneal biopsies and omentectomy should be standard procedures in thorough surgical staging among the available techniques. We aim to evaluate the role of routine omentectomy and random peritoneal biopsies in upstaging of apparent early-stage epithelial ovarian cancer(EOC) at tertiary-level-center.
Methodology We retrospectively analyzed data with patients aged-eighteen years or above with an apparent early-stage EOC who underwent surgical staging and treatment. Besides demographic and imaging parameters, we collected tumour histology and grades. In addition, operative-notes were reviewed for the extent of disease spread in pelvis and apparent stage, as well as whether the omentum and peritoneal surfaces in question appeared to have metastatic disease, and whether biopsies were of normal tissue(random-biopsy) or of abnormal appearing tissue(targeted-biopsy).Patients with positive lymph-nodes and evident abdominal disease were excluded
Results We performed 166 primary staging since January2017, with 72 being exclusively for EOC. Among these,20 revealed borderline-pathology. Histology for EOC were serous with 36% followed by mucinous(22%) and least with clear-cell-carcinoma(1%). Out of these,24% were positive on peritoneal-fluid analysis.12% had positive peritoneal biopsies. Among these,18% showed omental occult metastasis. Among 46 cases of clinical stage1a, 6 upstaged due to positive ascitic-fluid or peritoneal-fluid cytology, 3 due to ovarian surface involvement, 2 due to fallopian-tube involvement,1 due to positive pelvic peritoneal biopsy and 5 cases due to positive omental metastasis. In Stage 1b, 14 cases were upstaged. One surgical spill case was turned up with 3a omental metastasis. 2b stage upstaged with 1 case to 3a. Omentectomy is shown to improve upstaging and should be included in early-stage EOC staging laparotomy. Random peritoneal biopsies were not beneficial for early-stage EOC due to few positive outcomes in biopsies.
Conclusion Omentectomy is shown to improve upstaging and should be included in early-stage EOC staging laparotomy. Due to few positive outcomes in biopsies, random peritoneal biopsies do not appear to be beneficial for early-stage EOC.
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