Comparative analysis of peritonectomy techniques in detection of occult peritoneal disease in Interval cytoreductive surgery for advanced ovarian cancer (ToPIC)-An Exploratory randomised study

This is an Exploratory randomised control trial. aimed at comparing the different peritonectomy techniques in detection of occult peritoneal disease in Interval cytoredcutive surgery for advanced ovarian cancer

Background-The goal of iCRS is to obtain a complete gross resection or complete cytoreduction (CC-0 resection) which is achieved by resecting sites of visible residual disease. This includes total hysterectomy with bilateral salpingo oophorectomy, pelvic and/or para aortic lymphadenectomy, supracolic omentectomy, peritoneal resection and visceral resections wherever necessary. In advanced ovarian cancer, after first line treatment, approximately 10% of the patients will never develop a recurrence. For the remaining 90%, the disease will invariably recur, with the peritoneum being the only or one of the sites of recurrence in more than 80% of the patients.In stages III-C and IV, the diaphragmatic peritoneum is invariably involved. It has been shown that despite having a normal appearance after NACT, microscopic residual disease is present in 15%–35% of the patients

Purpose-The present study aims to analyse the role of extent of parietal peritonectomy on detection of  occult peritoneal metastatic disease, morbidity and rate of recurrence in women undergoing interval cytoreductive surgery for advanced epithelial ovarian cancers The rationale behind the study is to detect presence of occult disease in normal looking peritoneum so that adjuvant treatment can be planned accordingly. Also the percentage of occult disease detection will be compared in the arms i.e total vs involved field parietal peritonectomy versus multiple peritoneal biopsies in order to counterweigh occult disease detection versus increased surgical morbidity.