Document

Report
Pathologic Analysis of Tumour Destruction with Neutral Plasma in
Epithelial Ovarian Carcinoma
Madhuri TK1, Butler-Manuel SA1, Tailor A1 & Haagsma B2
1Department
of Gynaecological Oncology, 2Department of Histopathology
Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
Depth (mm)
Superficial Margin
(mm)
Cavity Base (mm)
Depth (mm)
Superficial Margin
(mm)
Cavity Base (mm)
Depth (mm)
Superficial Margin
(mm)
Cavity Base (mm)
Depth (mm)
Superficial Margin
(mm)
Cavity Base (mm)
Depth (mm)
Superficial Margin
(mm)
Cavity Base (mm)
Ovarian cancer (OC) accounted for 225,000 cases worldwide
in 2008 with 140,000 deaths recorded the same year.1 Deaths
from OC are more than all the other gynaecological cancers
combined.1Advanced EOC typically presents with widespread
metastases. However, surgical cytoreduction plays a key role in
improving overall survival (OS). Various studies including the
EORTC study by Vergote et al recommends that complete
resection of all macroscopic disease during debulking is the
single most important prognostic factor in advanced EOC.2
Until recently, surgery was considered optimal if residual
tumour </= 1cm remained. Today, optimal cytoreduction is
defined as removal of all visible macroscopic disease. Bulky
disease may be resected with radical surgery. However,
removal of miliary peritoneal and serosal metastases is
problematic and hence surface tumour ablation with innovative
surgical devices is an attractive proposition.
Various electrosurgical devices have been developed over the
years including the argon beam coagulator (ABC). All these
devices have specific applications with several disadvantages
including passing electric current through tissue to generate
heat, setup time, trained assistance, speed, intra-operative
lateral thermal spread (LTS) and variable collateral tissue
destruction (TD).
Exposure Time
(Seconds)
BACKGROUND
1
0.45
0.1
0.4
0.2
0.1
0.08
1
0.35
0.15
0.6
0.18
0.3
1
0.12
0.1
2
0.6
0.15
0.1
0.6
0.15
0.07
1.2
0.3
0.11
1
0.25
0.15
1.25
0.18
0.12
3
3
0.2
0.13
0.4
0.2
0.17
1.5
0.23
0.12
3.5
0.25
0.2
2.25
0.25
0.2
4
0.4
0.4
0.1
2
0.21
0.17
3.5
0.4
0.08
2.75
0.32
0.15
3.5
0.25
0.15
Power
Setting
10%
20%
40%
60%
80%
The results of examination of the tumour tissue (serous carcinoma from omental cake) are presented in
the Table
As expected the extent of tissue damage around the cavity on the surface of the specimen increased
with increasing exposure time and increasing power settings. The extent of this damage was small and
did not increase in direct proportion to the increased exposure and power.
Figure 1 showing cavity
at 40% setting (1sec)
Figure 2 showing eschar at 40%
setting (1sec)
Figure 3 showing cavity
at 40% setting (5sec)
Figure 4 showing eschar
at 40% setting (5 sec)
Aim
The aim of this study is to report the histopathological effects of TD
following PlasmaJet (PJ) use focussing on the power settings used
and tissue interaction time and its co-relation with the depth of
destruction and LTS.
Materials & Methods
Following consent from women undergoing debulking for EOC,
fresh tissue was harvested intra-operatively. Following tissue
excision, 1cm3 sections of tissue was exposed to PJ at varied
power settings and increasing time duration. These were formalinfixed and stained. Histological examination of tissue destruction
included assessment of cavity depth and extent of burn at the base
of cavity.
RESULTS
48 specimens from the omentum were analysed
Depth of Tissue Destruction
DTD was defined by the depth of the cavity left by the ablated tissue.
Lateral Thermal Spread
LTS was defined by the depth of histologically visible tissue damage.
This was measured from the surface of the eschar to the level of
normal tissue morphology.
DTD varied from 0.2 -3.5mm (mean 1.29)
LTS was minimal at all the settings mentioned. (mean: 0.22
range 0.1-0.4)
Tissue damage at the base of the cavity ranged from 0.07
to 0.4 mm (mean 0.15)
DISCUSSION
We previously explored the role of the PJ for various applications in
benign and malignant gynaecological procedures.3
In ovarian cancer debulking where optimal cytoreduction is desired,
the PJ appears to effectively ablate cancer cells effectively.
Minimal LTS and DTD is necessary especially when ablating tumour
deposits around viscera and bowel surfaces.
Increasing power and tissue interaction time resulted in effective
tumour ablation while still maintaining minimal LTD.
The extent of tissue ablation produced by PJ is dependent upon
both power settings and duration of exposure. However, increasing
these parameters did not seem to impact on lateral thermal spread
making the PJ an attractive electrosurgical device.
CONCLUSION
PJ appears to be an inherently safe device that may be used
for optimal cytoreduction on various tissue surfaces.
References
1. Office for National Statistics, 2011. Cancer Statistics registrations: registrations of Cancers diagnosed in
2008, England.
2. Vergote I, Trope CG, Amant F, Kristensen GB et al. Neoadjuvant Chemotherapy or Primary Surgery in
Stage IIIC or IV Ovarian Cancer. European Organization for Research and Treatment of CancerGynaecological Cancer Group; NCIC Clinical Trials Group. N Engl J Med 2010; 363:943-53.
3. Madhuri TK, Papatheodorou D, Tailor A, Sutton CJG, Butler-Manuel SA.
First clinical experience of argon neutral plasma energy in gynaecological surgery in the UK. Gynecol
Surg. 2010:7(4):423-425
Corresponding Author:[email protected]
PlasmaJet® is a trademark of Plasma Surgical, Ltd

similar documents