Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy?

Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy?

Highlights

► Visual estimation of tumor spread in advanced epithelial ovarian cancer is impaired by the use of neoadjuvant chemotherapy. ► This may lead to leaving microscopic residual tumor in the patient in interval debulking surgery.
► This hypothesis should be tested in prospective studies specifically designed to address this issue.

Abstract

Objective

Most cases of epithelial ovarian cancer (EOC) are diagnosed in an advanced stage. When the disease has spread intra-abdominally, complete surgical tumor debulking is the single most important prognostic factor. Neoadjuvant chemotherapy (NACT) before surgery can cause fibrosis and adhesions in the peritoneal cavity and may interfere with the perioperative evaluation of tumor spread. In this prospective study, we evaluated whether perioperative visual assessment of tumor dissemination is similar in patients undergoing primary and interval surgery for EOC.

Methods

Systematic visual evaluation of tumor spread was performed at the start of primary surgery/diagnostic laparoscopy (n = 39) or interval surgery (n = 16). Peritoneal cavity was divided into 22 anatomical regions. The carefully documented results of the visual assessment were compared with the histopathological analysis of 220 biopsies from primary and 92 biopsies from interval surgery.

Results

In primary surgery, perioperative visual estimation of tumor spread showed 98% sensitivity, 76% specificity and 95% accuracy compared to histopathology. The corresponding figures after NACT were 86%, 76% and 84%, respectively. The difference in sensitivity and accuracy in primary and interval operations was statistically significant (p < 0.001).

Conclusions

In advanced EOC, microscopically carcinomatous areas have a benign visual appearance more often after NACT than at primary surgery. NACT may interfere with the perioperative visual evaluation of tumor spread and thus lead to incomplete resection of tumor in potentially resectable areas.