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Surgical and systemic therapies for addressing occult disease in advanced epithelial ovarian cancer

  • Aditi Bhatt1,*,
  • Snita Sinukumar2
  • Praveen Kammar3
  • Sanket Mehta3

1Department of Surgical Oncology, Zydus Hospital, 380054 Ahmedabad, India

2Department of Surgical Oncology, Jehangir Hospital, 411001 Pune, India

3Department of Surgical Oncology, Saifee Hospital, 400004 Mumbai, India

DOI: 10.31083/j.ejgo4301005 Vol.43,Issue 1,February 2022 pp.87-105

Submitted: 16 September 2021 Accepted: 01 November 2021

Published: 15 February 2022

*Corresponding Author(s): Aditi Bhatt E-mail:


The incidence of peritoneal recurrence in advanced epithelial ovarian cancer (EOC) is high and could be attributed to the high prevalence of occult disease the persists despite complete cytoreductive surgery (CRS) and systemic chemotherapy. Several therapeutic approaches have been used to address such occult disease. Hyperthermic intraperitoneal chemotherapy (HIPEC) acts on microscopic disease as well as free intraperitoneal cancer cells shed during surgery, thus, reducing the risk of recurrence. Maintenance therapies like Poly ADP-Ribosyl Polymerase (PARP) inhibitors and the anti-angiogenic agent bevacizumab are used as maintenance therapies to delay recurrence. The most definitive way to eradicate such occult disease completely is resection of the peritoneum. The high preponderance of occult disease in the parietal peritoneum and some regions of the visceral peritoneum has led some surgeons to investigate the role of a total parietal peritonectomy (TPP) performed along with wide resection of the visceral peritoneum as a strategy for addressing occult disease. The mechanism of action differs from that of HIPEC and systemic therapies. It is possible that the benefit of each of these therapies is additive. EOC is a heterogeneous disease with a number of clinicopathological and molecular factors influencing the prognosis. There are likely to be different subgroups of patients that benefit from each of these 4 therapies or a combination of these. In this manuscript, we review the rationale and current evidence for the use of each of these therapies and discuss the potential role of a TPP in light of other therapies.


Advanced ovarian cancer; Cytoreductive surgery; Total parietal peritonectomy; HIPEC; PARP inhibitors; Antia-ngiogenic therapy

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Aditi Bhatt,Snita Sinukumar,Praveen Kammar,Sanket Mehta. Surgical and systemic therapies for addressing occult disease in advanced epithelial ovarian cancer. European Journal of Gynaecological Oncology. 2022. 43(1);87-105.


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