When is it safe to omit surgery in primary peritoneal cancer with small volume disease?

Our plain-English summary of When is it safe to omit surgery in primary peritoneal cancer with small volume disease?, by R. Pounds, S. Kehoe (Current Oncology Reports, 2015).

The study

• Authors: R. Pounds, S. Kehoe
• Journal: Current Oncology Reports
• Published: 2015;17(8):36
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary peritoneal cancer (PPC) is considered a very rare condition, with mesotheliomas deemed the only true PPC when considering the cellular content and embryological derivation of the peritoneum. However, in women, PPC are seen in much greater abundance than that in men and the type of cancer detected is often that of a serous epithelial carcinoma, histologically similar to serous ovarian carcinomas. The management is also similar, i.e. surgery and platin-based chemotherapy. The definition clinically of PPC is that of widespread carcinomatosis with normal-sized ovaries. The carcinomatosis is often extensive, and the only bulk disease may be within the omentum and achieving complete clearance of all disease at primary surgery unlikely. Thus, the concept of using chemotherapy as the main strategy is a reasonable approach and may well be the best single therapeutic option in some patients. This paper reviews the data on PPC and how this approach could be assessed.

In plain English

This article was a literature review. The authors reviewed recent studies of primary peritoneal cancer (PPC) in women, which resembles serous ovarian cancer, to ask whether surgery can ever safely be omitted. The article was not about asbestos. Citing another review, it stated only that peritoneal mesothelioma, a different cancer, is mainly caused by asbestos exposure, radiation and simian virus 40. A reviewed Danish database study found residual cancer after surgery in 70% of advanced PPC cases, versus 54.6% of ovarian and 45.5% of fallopian tube cancers. Another study of six chemotherapy cycles before surgery, in a mixed group listed as 72 ovarian and 10 PPC cases, reported that 80.5% of patients had a complete or partial response to chemotherapy alone. The authors noted that no proper prospective or randomised studies of PPC outcome existed, leaving retrospective series with inherent problems, and that successful results may be more likely to be published. They concluded the question could only be answered by a randomised trial, and that a trial with one arm omitting surgery seemed justifiable.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature; no new patients studied by the authors
• Who was studied: Published articles on primary peritoneal cancer in women and related cancers (ovarian, fallopian tube, peritoneal mesothelioma), listed in a table; the authors studied no patients themselves. The article distinguishes PPC from malignant peritoneal mesothelioma, which predominantly affects males.
• Exposure: The review concerned treatment (surgery and platinum-based chemotherapy), not asbestos. Asbestos is mentioned only in background, citing another review, as a main cause of mesothelioma along with radiation and simian virus 40 (SV40).
• Main results:
  • In a reviewed Danish gynaecological cancer database study (Schnack et al.), residual cancer after surgery was found in 70% of advanced PPC cases, compared with 54.6% of ovarian and 45.5% of fallopian tube cancers.
  • In a reviewed retrospective study of six cycles of chemotherapy before surgery in advanced disease where primary debulking surgery was unsuitable (da Costa Miranda et al.), in a mixed group listed in the table as 72 ovarian and 10 PPC cases, 80.5% of patients had a complete or partial response to chemotherapy alone. This figure is not specific to PPC.
  • The authors argued that a randomised trial with one arm omitting surgery would seem justifiable.
• The authors' conclusion: The authors concluded that whether it is safe to omit surgery in low-volume PPC can only be answered by a prospective randomised trial, because the available evidence contains multiple inherent biases.
• Limitations the authors state:
  • There are no proper prospective or randomised studies of PPC and outcome, so care rests on retrospective series with inherent problems.
  • Possible publication bias: successful surgical series may be published while conflicting results may not.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Peritoneum, Carcinoma, Chemotherapy, Omentum.

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