Perioperative outcomes and platinum resistant recurrence in patients undergoing protocol based total parietal peritonectomy during interval cytoreductive surgery for advanced ovarian cancer- results of the TORPEDO study

Background and aim The TORPEDO (CTRI/2018/12/016789) is the single-arm, prospective, interventional study evaluating the role of a total parietal peritonectomy (TPP) in patients undergoing interval cytoreductive surgery (iCRS). In this manuscript, we report the perioperative outcomes and platinum resistant recurrence (PRR) in 218 patients enrolled in the study. Methods A TPP was performed in all patients undergoing iCRS irrespective of the residual disease extent. HIPEC was performed as per the clinician’s discretion with 75mg/m2 of Cisplatin. Maintenance therapy was also used at the discretion of the treating clinicians. Results From 9 th December 2018 to 31 st July 2022 (recruitment complete), 218 patients were enrolled at 4 Indian centres. The median surgical PCI was 14 and a complete gross resection was achieved in 95.8%. HIPEC was performed in 130 (59.6%) patients. The 90-day major morbidity was 17.4% and 2.7% patients died within 90 days of surgery. Adjuvant chemotherapy was delayed beyond 6 weeks in 7.3%. At a median follow-up of 19m [95% CI 15-35m], 101 (46.3%) recurrences and 19 (8.7%) deaths had occurred. The median PFS was 22m [95% CI 17-35m] and the median OS not reached. Platinum resistant recurrence was observed in 6.4%. The projected 3-year OS was 81.5% and in 80 patients treated before may 2020, it was 77.5%. Conclusions The morbidity and mortality of TPP with or without HIPEC performed during iCRS is acceptable. The incidence was of PRR is low. Early survival results are encouraging and warrant conduction of a randomized controlled trial comparing TPP with conventional surgery.