Eco-responsible and rational interval debulking surgery for high-grade ovarian carcinomas: An observational, ambispective cohort study

Background Since the workload generated by interval debulking surgeries (IDS) for advanced high-grade tubo-ovarian carcinomas is high in the surgical pathology department (SPD), we aimed to assess the impacts of implementing an eco-responsible protocol to manage specimens from IDS. Methods The protocol (ECO-IDS) defined the specimens to send to the SPD and the sampling strategy during gross examination. Twenty patients were prospectively included (post-ECO-IDS group). A retrospective cohort of 20 patients, who did not benefit from the protocol, was built (pre-ECO-IDS group). Criteria compared were: the number of jars sent/paraffin blocks prepared, pathology procedures' carbon footprint, financial cost of specimen processing, time for pathology report validation, and chemotherapy response score (CRS). Next-generation sequencing (NGS) was performed to ensure the feasibility of molecular techniques on the post-ECO-IDS samples. Results The median number of jars sent per patient was 4 (post-ECO-IDS group) versus 14 (pre-ECO-IDS group; p < 0.0001). The median number of paraffin blocks prepared per patient was 12.5 (post-ECO-IDS group) versus 38 (pre-ECO-IDS group; p < 0.0001). The median carbon footprint per patient was 8.6 KgCO 2 eq (post-ECO-IDS group) versus 24.1 KgCO 2 eq (pre-ECO-IDS group; p < 0.0001). The median financial cost was €25.5 (post-ECO-IDS group) versus €57.9 (pre-ECO-IDS group; p < 0.0001). The mean time for pathology report validation was 7.5 days (post-ECO-IDS group) versus 10 days (pre-ECO-IDS group; p = 0.0131). There was no difference in CRS between both groups. NGS identified TP53 variants in 19/20 (95%) tumors. Conclusion Our protocol reduced environmental impacts, financial costs, and time to pathology report validation, without compromising the quality/safety of histopathology results.