Complete Cytoreduction of Advanced Ovarian
Malignancy using Neutral Argon Plasma
Madhuri TK , Tailor A , Butler-Manuel SA
Department of Gynaecological Oncology
Royal Surrey County Hospital, Guildford, UK
Introduction
Ovarian cancer is 2nd common gynaecological cancer after breast and is
the commonest cause of death. Management includes surgery and
chemotherapy with a good initial response but women often relapse.1
Data has consistently shown that complete cytoreductive surgery improves
survival. 2 (figure 1 & 2)
There has been no new technology since 2001 when the Argon Beam
coagulator (ABC) was used to produce complete cytoreduction. The
PlasmaJet™ (PJ) is a new surgical device releasing neutral argon plasma.
Prospective, observational study performed with satisfactory results. 3
Figure 2 PJ being used to ablate
tumour nodules on bowel surfaces.
Figure 3 PJ coagulating bleeding
areas on bowel surfaces.
Results
Laparotomy (L)
15 primary debulking procedures for advanced ovarian cancer
Laparoscopy (LY)
6 secondary debulking procedures for recurrent ovarian cancer
Procedure
Pooled data from Chu et al confirms that optimal surgery is associated with
increased survival. (Table 1)
Traditionally the benchmark for optimal surgery has been <1cm
macroscopic residual.
Today, the aim of complete cytoreduction is to leave no macroscopic
residual disease.
Aim
Evaluate the feasibility and outcome of conversion from optimal
cytoreduction (</=1cm) to microscopic disease only in open and
laparoscopic surgery.
Survival of Patients in months With Advanced Ovarian Cancer According to
the Amount of Residual Tumor after Primary Cytoreduction
First Author
Year
Optimal
Suboptimal
No of
Patients
Intra op
transfusion
Post op
transfusion
L
15
2
6 on day 2
LY
6
1
0
Stage of
Disease
No of
cases
Stage 3c
13
Stage 4
8
Hospital stay
(in days)
4-8
Mean 5.8
1-3
Mean 2.2
Power
Settings
Disease free
interval
(Median)
19(12-26)
10-20%
15
12(9-19)
10-20%
9
Disease free
survival following
1ºtreatment
Residual disease: complete cytoreduction achieved in 17 cases.
No intra op/post op complications
Safe to use as compared with other devices
Easy to use
Discussion
Plasma: a collection of high energy small particles including free atoms, ions
and electrons produced by heating a gas. PJ is a new device for clinical use
designed to produce a fine jet of Argon plasma by heating argon gas.
Pohl
1984
450
16
Conte
1985
25+
14
Posada
1985
30+
18
Louie
1986
240
15
Redman
1986
370
26
Neijt
1987
400
21
Hainsworth
1988
720
13
Piver
1988
480
31
Conclusion
Sutton
1989
450
23
Widely applicable to a wide variety of open and laparoscopic gynae surgery
410
18
Mean
Materials & Methods
Prospective study in tertiary oncology centre. PJ used in 15
laparotomies and 6 laparoscopic debulking.
Patient demographics, intra and post-operative data collected.
Size/location of pre-surgical disease, procedures performed,
tissue and anatomical location subjected to PJ, power settings
and time taken to ablate tumour deposits recorded.
PJ used to treat peritoneal deposits of EOC metastases on serosal surface
of small and large bowel in all 11/15 open cases and treat deposits on the
serosal surface of the liver, diaphragm and peritoneal undersurface of the
pericardium with no adverse affects in the 6 laparoscopic cases. 4/6
presented with recurrent disease >19 months following treatment. Disease
on liver surface and diaphragmatic nodules resected with no visible disease.
Innovative surgical device to achieve optimal cytoreduction by ablation and
destruction of tumour implants on visceral surfaces without the risk of lateral
thermal spread in open or laparoscopic debulking surgery
Prospective, multicentre RCTs required to establish place in Gynaecological
Oncology
References
1.
2.
3.
4.
Correspondence to: t.madhuri@surrey.ac.uk
http://info.cancerresearchuk.org/cancerstats/types/ovary/?script=true
Heintz AP, Odicino F, Maisonneuve P et al. Carcinoma of the ovary. FIGO 6th Annual Report on the Results of
Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006; 95 (Suppl 1): S161–92.
Madhuri TK, Papatheodorou D, Tailor A, Sutton CJ, Butler-Manuel SA. First clinical experience of argon neutral
plasma energy in gynaecological surgery in the UK. Gynecol Surg. DOI 10.1007/s10397-010-0591-2
Sonoda Y, Overa N, Chi DS, Brown, CL et al. Pathologic Analysis of Ex-vivo Plasma Energy Tumor
Destruction in Patients with Ovarian or Peritoneal Cancer. Proceedings from SGO Annual Congress 2009.
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