Introduction In spite of doing selective disease directed peritonectomy, fluoroscopic imaging & microscopy of remaining peritoneum has shown presence of disease that is not visible to naked eyes.Aim of this study was to assess the recurrence, oncological outcomes (DFS & OS), morbidity & mortality extent of parietal peritonectomy with CRS & HIPEC.

Methods Patients diagnosed Ca Ovary underwent total parietal peritonectomy (TPP) or involved parietal peritonectomy (IPP) with CRS & HIPEC. All data prospectively entered in the HIPEC registry was analyzed.

Results 163 cases,38 upfront, 76 interval and 49 recurrent ovarian cancer case. Prior surgical score was 0,1,2,3 (101, 18, 38, 6) . 70 & 93 patients underwent TPP & IFP respectively. TPP group had higher PCI (16 vs 14), duration of surgery (11 vs 9hrs), blood loss (1243 vs 675ml) and hospital stay (16 vs 12) days when compared to IPP group. The number of diaphragmatic and bowel resections were comparable in both group but TPP group had multivisceral resections. G3-G5 morbidity both groups 43% vs 33%. TPP group had increased intra-pleural & intra-abdominal collections which need intervention. Median follow up of 45 months, TPP vs IPP group DFS (26 vs 21 months) and OS (not yet reached respectively vs 46months). Most common recurrence in TPP was lymph nodes 55% (27%) vs IPP peritoneal (45%).

Conclusion/Implications Total parietal peritonectomy shifts recurrence patterns from peritoneal to systemic and demonstrates better DFS. Fluid management post-surgery is critical. A prospective randomized multi-institutional study needs to be designed for more evidence.