Visual assessment of residual peritoneal disease during interval cytoreductive surgery: a prospective comparison of...

Complete cytoreduction remains the cornerstone of treatment in advanced epithelial ovarian cancer, but tissue alterations following neoadjuvant chemotherapy can obscure residual disease and hinder accurate intraoperative assessment. There is currently no standardized or validated method to reliably detect residual disease in this context. This pilot study evaluates whether laparoscope-assisted visualisation during interval cytoreductive surgery improves detection of peritoneal metastases compared to gross inspection. We hypothesise that enhanced visualisation may improve diagnostic performance and support more accurate surgical decision-making.

This prospective study included 31 patients with advanced epithelial ovarian cancer who received platinum based neoadjuvant chemotherapy and underwent interval cytoreductive surgery. Twelve predefined peritoneal sites were assessed by gross inspection followed by laparoscope-assisted visualisation. Suspicious areas defined as subtle surface changes without overt nodularity were biopsied and sent for histopathology.

Thirty-one patients underwent evaluation at 12 abdominal sites, yielding 372 total assessments. Laparoscope-assisted visualisation showed higher sensitivity (72.1%) than gross inspection (54.1%) but lower specificity (50.2% vs 80.8%) and accuracy (56.7% vs 80.9%) (p < 0.001). Positive predictive value was higher with gross inspection (54.6% vs 38.1%), while negative predictive value was similar. Overdiagnosis was greater with laparoscopy (61.9%) than gross inspection (45.5%). Agreement with histopathology was fair for gross (κ = 0.35) and poor for laparoscopic (κ = 0.17) assessment. The greater omentum yielded the highest tumour positivity (64.5%).

Laparoscope-assisted visualisation improved sensitivity, while gross visualisation demonstrated higher specificity and overall accuracy. The limited agreement between methods and with histopathology highlights the need for more objective intraoperative tools to enhance disease detection.