Peritoneal implant elimination during cytoreductive surgery for ovarian cancer: impact on survival

A case-control study was performed to evaluate the potential benefit of peritoneal and serosal implant elimination (PIE) during primary cytoreductive surgery for patients with Stage IIIC epithelial ovarian cancer. Peritoneal implant excision and/or ablation was accomplished with electrocautery, CO2 laser, sharp dissection, argon beam coagulator, and cavitron ultrasonic surgical aspirator. Three groups of patients were compared: Group A (7 patients); macroscopically disease-free after cytoreduction without needing PIE; Group B (26 patients); macroscopically disease-free after cytoreduction, including PIE; Group C (34 patients); macroscopic disease < or = 1 cm remaining exclusively on peritoneal surfaces with PIE not attempted. Each group had statistically equivalent mean ages, estimated blood loss, extent of disease, and variety of cytoreductive operations performed. Group B had a longer mean operating time than that of A or C (4.0 vs 2.8 hr P = 0.002). No serious morbidity occurred from PIE. Comparison of survival by log rank analysis and Cox proportional hazards regression shows a survival advantage for patients rendered free of macroscopic peritoneal implants (Group B vs Group C; P = 0.003). The result suggests that complete elimination of all visible peritoneal metastases might be of benefit during surgical cytoreduction for ovarian cancer if this renders the patient macroscopically disease-free. We also suggest the need of a randomized, prospective study to clarify the clinical role of PIE.