The role of omentectomy and random peritoneal biopsies as part of comprehensive surgical staging in apparent early-stage epithelial ovarian cancer

Ann Surg Oncol. 2014 Aug;21(8):2762-6. doi: 10.1245/s10434-014-3648-z. Epub 2014 Apr 28.

Abstract

Background: Comprehensive surgical staging plays an important role in apparent early-stage epithelial ovarian cancer (eEOC). However, few studies have evaluated how often upstaging occurs solely as a result of microscopic metastases identified from omentectomy and random peritoneal biopsies. The purpose of this study was to evaluate the significance of omentectomy and random peritoneal biopsies for normal-appearing tissues in eEOC.

Methods: A retrospective study was performed of patients with eEOC [International Federation of Gynecology and Obstetrics (FIGO) Stages I-IIIA] between 1991 and 2010. The demographic characteristics, surgical findings, and pathologic variables were analyzed.

Results: In total, 324 patients were included in the study. Of 127 patients who underwent random peritoneal biopsies, 6 (4.7 %) were upstaged to IIB or IIC based solely on pelvic peritoneal biopsy findings and 3 (2.4 %) were upstaged to IIIA based on abdominal peritoneal biopsy findings. Of 256 patients who underwent omentectomy, 7 (2.7 %) were upstaged to IIIA based on microscopic metastases identified in the normal-appearing omentum. Following routine omentectomy and random peritoneal biopsies, only one patient in our cohort experienced a change in her adjuvant treatment recommendation.

Conclusions: Although the rate of upstaging based on routine omentectomy and random peritoneal biopsies is not negligible, there is a low chance that the treatment plan will be altered to include chemotherapy after surgery as a result of the occult microscopic metastases identified.

MeSH terms

  • Adenocarcinoma, Clear Cell / pathology*
  • Adenocarcinoma, Clear Cell / surgery
  • Adenocarcinoma, Mucinous / pathology*
  • Adenocarcinoma, Mucinous / surgery
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Cystadenocarcinoma, Serous / pathology*
  • Cystadenocarcinoma, Serous / surgery
  • Endometrial Neoplasms / pathology*
  • Endometrial Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Staging
  • Omentum / surgery*
  • Ovarian Neoplasms / pathology*
  • Ovarian Neoplasms / surgery
  • Peritoneum / surgery*
  • Prognosis
  • Young Adult