Total Peritoneal Gutter Removal versus Random Peritoneal Biopsy in Cases of Ovarian Cancer

Introduction: Ovarian cancer is the fourth most prevalent cancer among women and the seventh most common cancer overall. Every year, an estimated 200,000 cases and 125,000 deaths related to ovarian cancer are reported around the world. It is most common in high-resource countries, with an incidence rate of 9.3 per 100,000 women. Ovarian cancer is detected at an advanced stage in about 70% of instances, and only 30% of women with such cancers live for more than 5 years. Although only around 20% of ovarian cancers are limited to the ovaries at diagnosis, patients with localized disease have a 5-year survival rate of more than 90%. Peritonectomy is a crucial part of the surgical treatment for ovarian cancer. Visual inspection and palpation are not reliable methods for determining the extent of tumour involvement. The majority of gynecologic oncologists are suspicious about the benefits of a full peritonectomy, concerned about the benefits and hazards. They believe that the tumor’s fundamental biology, not surgical aggressiveness, dictates the tumor’s resectability. The aim of this work was primarily to compare the differences between total peritoneal gutter removal and random peritoneal biopsy in cases of early ovarian cancer. A secondary aim of this work is to show ability of total peritoneal gutter removal in relation to that of random peritoneal biopsy to detect positivity of metastasis in the histopathological specimens. Patients and Methods: This prospective cohort study was conducted on 130 patients with early ovarian cancer in El-Shatby hospital, Faculty of Medicine, Alexandria University. For each patient, we took random and total peritoneal biopsy and compared between them regarding technique, timing, post-operative complications, and histopathological results. Inclusion criteria: all age group, suspected ovarian cancer using IOTA score, absence of nodules in the peritoneal gutter using CT and any case that needs staging laparotomy for ovarian cancer. Exclusion criteria: presence of gross peritoneal disease in the gutter and CT features of advanced ovarian cancer (peritoneal deposits, omental cakes, pelvic and para-aortic lymphadenopathy). All cases will be subjected to the followings: history taking, clinical examination, suspicious ovarian mass using IOTA score, tumor markers, CT staging, staging laparotomy and random and total peritoneal biopsies will be collected from the same case and sent to the lab of pathology for histopathological examination and the results will be compred regarding positivity of metastasis. Results: Random peritoneal biopsy showed positive metastasis in 6 (4.6%) cases and free in 124 (95.4%) cases while total peritoneal gutter removal showed positive metastasis in 19 (14.6%) cases and free in 111 (85.4%) with Chi-square test was 7.479 and P value was 0.004 which is statistically significant. 108 (97.3%) cases had negative random peritoneal biopsy and negative total peritoneal gutter removal, 3 (2.7%) cases had positive random peritoneal biopsy and negative total peritoneal gutter removal, 16 (84.2%) cases had positive total peritoneal gutter removal and negative random peritoneal biopsy & 3 (15.8%) cases had positive total peritoneal gutter removal and positive random peritoneal biopsy with Chi-square test 6.311, FEp 0.04 and Kappa test 0.183 (0.012) which is statistically significant with poor strength of agreement. Conclusions: Modified total peritoneal gutter removal is a safe, fast and easy technique compared to random peritoneal biopsy and even to traditional peritonectomy procedure with high detection rates of peritoneal involvement with sensitivity of 50% and specificity of 87.5% and it is recommended to be done as a routine alternative to random peritoneal biopsy and even to traditional total gutter removal in all cases of ovarian malignancies for diagnostic and therapeutic values.