PELVIC AND PERIAORTIC PERITONEAL CLOSURE OR NON-CLOSURE AT LYMPHADENECTOMY IN OVARIAN-CANCER - EFFECTS ON MORBIDITY AND ADHESION FORMATION

The effects of pelvic and periaortic peritoneal closure or (non-closur e) on morbidity and adhesion formation were prospectively compared in 102 patients with ovarian cancer who had undergone a pelvic and periao rtic lymphadenectomy. Hysterectomy with bilateral salpingoophorectomy, bilateral pelvic and periaortic lymphadenectomy, omentectomy, appende ctomy and lysis of pelvic adhesions for the standardization of initial adhesion scores was performed on all patients. The pelvic and periaor tic peritoneum were re-approximated in group I (n=50) patients, and le ft open in group II (n=52) patients. The groups were similar for mean age, previous surgery, tumour histology and disease stage, Morbidity c haracteristics such as blood loss, transfusion rate, post-operative in fectious and non-infectious complications, and total hospital stay wer e also similar. After six courses of PAC (cisplatin 50 mg/m(2), Adriam ycin 50 mg/m(2), cyclophosphamide 500 mg/m(2)) chemotherapy, all patie nts underwent a second-look laparotomy. Persistent cancer was detected in 49 of 102 (48.03%) patients. Adhesion scores were detected at the time of second-look laparotomy. Adhesion scores for group I (8.9+/-2.9 ) were significantly higher than the group II (peritoneum non-closure) (5.8+/-2.3) (P<0.01). Closing the pelvic and periaortic peritoneum di d not effect morbidity, but leaving the pelvic and periaortic peritone um open significantly decreased the adhesion formation.