EXPANDED POLYTETRAFLUOROETHYLENE IS AN EFFECTIVE BARRIER IN PREVENTING PELVIC ADHESIONS AFTER RADICAL SURGERY FOR OVARIAN-CANCER

Objective: To determine the efficacy of expanded polytetrafluoroethyle ne(ePTFE) in preventing pelvic adhesions following primary surgical de bulking of epithelial ovarian cancer. Methods: Twenty-one patients wit h advanced ovarian cancer undergoing optimal debulking including excis ion of the pelvic peritoneum were randomized intraoperatively to eithe r a control group or to a subset undergoing coverage of the pelvic per itoneal defect with ePTFE. Following chemotherapy, a second look proce dure was performed and adhesions scored. The pelvis was divided into q uadrants, and each quadrant was assessed for the extent and type of ad hesion 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 gro up were compared using a two-tailed Fisher's exact and t-test, respect ively. Results: Thirteen patients (six ePTFE recipients and seven-cont rols) were evaluable and underwent surgical reassessment while six eit her refused second look (N = 2) and/or chemotherapy (AT = 2) or progre ssed (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 pe lvic quadrants covered with ePTFE contained adhesions compared to 86% (24 of 28) in the control group (P = 0.001). The mean total quadrant a dhesion 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 loo p adhesions, organ/ structure involvement and postoperative complicati ons was similar in both groups. Conclusions: An ePTFE membrane is effe ctive in preventing pelvic adhesions after radical debulking for ovari an cancer. The clinical implications associated with its use, however, require further study.