Pathologic Analysis of Tumour Destruction with Neutral Plasma in Epithelial Ovarian Carcinoma

1
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 HistopathologyRoyal
Surrey County Hospital NHS Foundation Trust,
Guildford, UK
BACKGROUND 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 lt/ 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) 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)
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 10 10 20 20 20 40 40 40 60 60 60 80 80 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)
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 formalin-fixed and stained.
Histological examination of tissue destruction
included assessment of cavity depth and extent of
burn at the base of cavity.
Figure 3 showing cavity at 40 setting (5sec)
Figure 4 showing eschar at 40 setting (5 sec)
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.
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)

• References
• Office for National Statistics, 2011. Cancer
  Statistics registrations registrations of
  Cancers diagnosed in 2008, England.
• 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
  Cancer-Gynaecological Cancer Group NCIC Clinical
  Trials Group. N Engl J Med 2010 363943-53.
• 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. 20107(4)423-425

Corresponding Authordocmadhuri231_at_doctors.org.uk
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