Abstract
Objective: To determine the efficacy of expanded polytetrafluoroethylene(ePTFE) in preventing pelvic adhesions following primary surgical debulking of epithelial ovarian cancer.
Methods: Twenty-one patients with advanced ovarian cancer undergoing optimal debulking including excision of the pelvic peritoneum were randomized intraoperatively to either a control group or to a subset undergoing coverage of the pelvic peritoneal defect with ePTFE. Following chemotherapy, a second look procedure was performed and adhesions scored. The pelvis was divided into quadrants, and each quadrant was assessed for the extent and type of adhesion involvement (avascular, vascular, thick) and given a composite score (range 0-20). In addition, any visceral structures involved with adhesions were noted. The number of quadrants involved with adhesions and the mean adhesion scores between the control and experimental group were compared using a two-tailed Fisher's exact and t-test, respectively.
Results: Thirteen patients (six ePTFE recipients and seven-controls) were evaluable and underwent surgical reassessment while six either refused second look (N = 2) and/or chemotherapy (AT = 2) or progressed (N = 2). One patient in both the ePTFE and control groups died of disease prior to reassessment. Forty-two percent (10 of 24) of the pelvic quadrants covered with ePTFE contained adhesions compared to 86% (24 of 28) in the control group (P = 0.001). The mean total quadrant adhesion score was also lower when ePTFE was used, 1.6 +/- 3.2 (range 0-8) vs 8.7 +/- 5.7 (range 2-17) (P = 0.01). The incidence of bowel loop adhesions, organ/ structure involvement and postoperative complications was similar in both groups.
Conclusions: An ePTFE membrane is effective in preventing pelvic adhesions after radical debulking for ovarian cancer. The clinical implications associated with its use, however, require further study.