Total Retroperitoneal En Bloc Resection of Multivisceral-Peritoneal Packet (TROMP Operation): A Novel Surgical Technique for Advanced Ovarian Cancer; Retrospective Cohort Analysis of a Prospective Collected Database

Abstract

Background: a total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation) is a no-touch isolation technique in a retroperitoneal space to resect the parietal peritoneum and the affected organs in advanced ovarian cancer. The study prescribed and analyzed the results of this novel technique for primary cytoreductive surgery. Methods: The study included 208 patients operated between January 2015 and December 2017 in Charite, Berlin. TROMP operation was performed in 58 patients, whereas the other 150 patients were operated with the conventional cytoreductive method. Findings: The complete tumor resection rate accounts for 87.9% in TROMP group and 61.3% in the conventional surgery group. (P=0.001). This difference was even stronger in the sub-group of very advanced stages (T3c+T4) (85.1% of TROMP group and in only 53.1% in the conventional surgery group, P=0.001). The duration of the primary cytoreductive surgery was about 33 minutes shorter in TROMP group (median: 335 minutes vs. 368 minutes; TROMP vs. conventional, respectively) in spite of the fact that the most advanced cytoreductive procedures were performed statically significant more in TROMP operation arm in comparison with the conventional surgery arm. There was no statistically significant difference between the groups regarding the postoperative complication, blood loss or the length of stay in intensive care unit. Interpretation: TROMP operation is a visible and very effective technique of surgical therapy in advanced ovarian cancer. This technique increased the complete tumor resection rate to 87.9% without increasing the blood loss, postoperative complications or the duration of surgery. A prospective randomized study is advised to validate these results. Funding Statement: The authors received no specific funding for this work. Declaration of Interests: 1. The first (MZM) author is an adviser for Stryker. He received in the last 2 yours honoraria from Olympus, Ethicon (Johnson and Johnson), Roche and Astrazeneca. 2. The second author (JS) received honoraria from Astrazeneca, Eisai, Clovis, Olympus, Johnsons and Johnson, PharmaMar, Pfizer, TEVA, TESARO, MSD and plays advisory roles by Astrazeneca, Clovis, Lilly, PharmaMar, Pfizer, Roche, TESARO, MSD. He received even research fundings (not for this study) from Astrazeneca, Clovis, Merck, Bayer, PharmaMar, Pfizer, TESARO, MSD. He discloses travel, accommodations, and other expenses paid or reimbursed by Astrazeneca, Clovis, PharmaMar, Roche, Pfizer, TESARO, MSD, and were parts of his scientific activities in the last 2 years. 3. The third author (AM) has no conflict of interest. 4. The fourth author (RR) has no conflict of interest. 5. The fifth author (JM) has no conflict of interest. Ethics Approval Statement: All patients provided their written informed consent before clinical data were collected. Approval from Charite local Ethics Committee was provided for this study (EK207/2003 Amendment 15/2012).