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Tozzi F, Matthys R, Molnar A, Ceelen W, Vankerschaver J, Rashidian N, Willaert W. Assessment of Intraoperative Scoring Systems for Predicting Cytoreduction Outcome in Peritoneal Metastatic Disease: A Systematic Review and Meta-analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15629-7. [PMID: 38918326 DOI: 10.1245/s10434-024-15629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Cytoreductive surgery (CRS) is a widely acknowledged treatment approach for peritoneal metastasis, showing favorable prognosis and long-term survival. Intraoperative scoring systems quantify tumoral burden before CRS and may predict complete cytoreduction (CC). This study reviews the intraoperative scoring systems for predicting CC and optimal cytoreduction (OC) and evaluates the predictive performance of the Peritoneal Cancer Index (PCI) and Predictive Index Value (PIV). METHODS Systematic searches were conducted in Embase, MEDLINE, and Web of Science. Meta-analyses of extracted data were performed to compare the absolute predictive performances of PCI and PIV. RESULTS Thirty-eight studies (5834 patients) focusing on gynecological (n = 34; 89.5%), gastrointestinal (n = 2; 5.3%) malignancies, and on tumors of various origins (n = 2; 5.3%) were identified. Seventy-seven models assessing the predictive performance of scoring systems (54 for CC and 23 for OC) were identified with PCI (n = 39/77) and PIV (n = 16/77) being the most common. Twenty models (26.0%) reinterpreted previous scoring systems of which ten (13%) used a modified version of PIV (reclassification). Meta-analyses of models predicting CC based on PCI (n = 21) and PIV (n = 8) provided an AUC estimate of 0.83 (95% confidence interval [CI] 0.79-0.86; Q = 119.6, p = 0.0001; I2 = 74.1%) and 0.74 (95% CI 0.68-0.81; Q = 7.2, p = 0.41; I2 = 11.0%), respectively. CONCLUSIONS Peritoneal Cancer Index models demonstrate an excellent estimate of CC, while PIV shows an acceptable performance. There is a need for high-quality studies to address management differences, establish standardized cutoff values, and focus on non-gynecological malignancies.
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Affiliation(s)
- Francesca Tozzi
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Rania Matthys
- Department of General, Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Adris Molnar
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Joris Vankerschaver
- Department of Applied Mathematics, Informatics and Statistics, Center for Biosystems and Biotech Data Science, Ghent University Global Campus, Incheon, Korea
| | - Niki Rashidian
- Department of General, Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Wouter Willaert
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
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Li J, Duan J, Zhu M, Jiang W. Transabdominal resection of the metastatic lymph nodes at the level of the celiac trunk. Int J Gynecol Cancer 2023:ijgc-2023-004871. [PMID: 37813477 DOI: 10.1136/ijgc-2023-004871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- Jun Li
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jie Duan
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Menghan Zhu
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wei Jiang
- Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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3
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Vergriete K, Angeles MA, Daix M, Leray H, Chantalat E, Ferron G. Celiac lymph node dissection and peri-hepatic peritonectomy in 10 steps. Int J Gynecol Cancer 2022; 32:572-573. [DOI: 10.1136/ijgc-2021-003133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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4
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Huang H, Wei R, Long Y, Mo Y, Xie Y, Yao D. Hepatic Hilar Lymph Node Resection in Cytoreductive Surgery for Advanced Ovarian Cancer: A Necessity or Not? Cancer Manag Res 2021; 13:7981-7988. [PMID: 34707404 PMCID: PMC8542736 DOI: 10.2147/cmar.s334658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This review aims to clarify the necessity of hepatic hilar lymph node resection on advanced ovarian cancer patients. Background PARP inhibitors and surgery have significantly improved the survival of patients with ovarian cancer. However, for patients with advanced ovarian cancer, there are often extensive epigastric disseminated metastatic lesions, especially the lymph nodes in the hepatic hilar area. Because of the complicated anatomical relationship and lack of experience in this area, this is easily ignored by gynecological oncologists. Methods Through the retrieval and analysis of the current database, namely PubMed, Medline, Web of Science, EMBASE, Cochrane Library, and Wangfang, etc., the literature regarding this topic published before March 2021 were thoroughly investigated. Conclusion For the hepatic hilar regional lymph node surgery, through careful preoperative evaluation, surgical-indication clarification, appropriate case selection, standardized surgical operations and multidisciplinary cooperation with general surgeons, the prognosis of patients is significantly improved. Postoperative complications are also safe and controllable and convincing. To conclude, the application of hilar region lymph node cytoreductive surgery for patients with advanced ovarian cancer is a feasible and preferred choice.
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Affiliation(s)
- Honglian Huang
- Hechi People's Hospital, Hechi City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Renjie Wei
- Hechi People's Hospital, Hechi City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Ying Long
- Gynecologic Oncology Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yu Mo
- Hechi People's Hospital, Hechi City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yu Xie
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Desheng Yao
- Gynecologic Oncology Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning City, Guangxi Zhuang Autonomous Region, People's Republic of China
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Tsonis O, Gkrozou F, Vlachos K, Paschopoulos M, Mitsis MC, Zakynthinakis-Kyriakou N, Boussios S, Pappas-Gogos G. Upfront debulking surgery for high-grade serous ovarian carcinoma: current evidence. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1707. [PMID: 33490219 PMCID: PMC7812243 DOI: 10.21037/atm-20-1620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
High-grade serous ovarian carcinoma (HGSOC) is a leading cause of mortality among women worldwide. Currently, there is no clear consensus over the regime these patients should receive. The main two options are upfront debulking surgery with adjuvant chemotherapy or neoadjuvant chemotherapy followed by interval debulking surgery (IDS). The former approach is proposed to be accompanied by lower chemoresistance rates but could lead to severe surgical comorbidities and lower quality of life (QoL). Optimizing patient’s selection for upfront debulking surgery might offer higher progression-free and overall survival rates. Further studies need to be conducted in order to elucidate the predictive factors, which are favorable for patients undergoing upfront debulking surgery in cases of high-grade serous ovarian cancer.
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Affiliation(s)
- Orestis Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospitals Birmingham, Birmingham, UK
| | - Konstantinos Vlachos
- Department of General Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Michail C Mitsis
- Department of General Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK.,AELIA Organization, Thessaloniki, Greece
| | - George Pappas-Gogos
- Department of General Surgery, University Hospital of Ioannina, Ioannina, Greece
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Di Donato V, Giannini A, D'Oria O, Schiavi MC, Di Pinto A, Fischetti M, Lecce F, Perniola G, Battaglia F, Berloco P, Muzii L, Benedetti Panici P. Hepatobiliary Disease Resection in Patients with Advanced Epithelial Ovarian Cancer: Prognostic Role and Optimal Cytoreduction. Ann Surg Oncol 2020; 28:222-230. [PMID: 32779050 PMCID: PMC7752869 DOI: 10.1245/s10434-020-08989-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/31/2020] [Indexed: 12/26/2022]
Abstract
Objective The purpose of this study was to evaluate the feasibility and safety in terms of prognostic significance and perioperative morbidity and mortality of cytoreduction in patients affected by advance ovarian cancer and hepato-biliary metastasis. Methods Patients with a least one hepatobiliary metastasis who have undergone surgical treatment with curative intent of were considered for the study. Perioperative complications were evaluated and graded with Accordion severity Classification. Five-year PFS and OS were estimated using the Kaplan–Meier curve. Results Sixty-seven (20.9%) patients had at least one metastasis to the liver, biliary tract, or porta hepatis. Forty-four (65.7%) and 23 (34.3%) patients underwent respectively high and intermediate complexity surgery according. Complete cytoreduction was achieved in 48 (71.6%) patients with hepato-biliary disease. In two patients (2.9%) severe complications related to hepatobiliary surgery were reported. The median PFS for the patients with hepato-biliary involvement (RT = 0 vs. RT > 0) was 19 months [95% confidence interval (CI) 16.2–21.8] and 8 months (95% CI 6.1–9.9). The median OS for the patients with hepato-biliary involvement (RT = 0 vs. RT > 0) 45 months (95% CI 21.2–68.8 months) and 23 months (95% CI 13.9–32.03). Conclusions Hepatobiliary involvement is often associated with high tumor load and could require high complex multivisceral surgery. In selected patients complete cytoreduction could offer survival benefits. Morbidity related to hepatobiliary procedures is acceptable. Careful evaluation of patients and multidisciplinary approach in referral centers is mandatory. Electronic supplementary material The online version of this article (10.1245/s10434-020-08989-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy.
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Ottavia D'Oria
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Michele Carlo Schiavi
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Anna Di Pinto
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Francesca Lecce
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Francesco Battaglia
- Department Obstetrics and Gynecological Hospital Santa Maria Goretti of Latina, "Sapienza" University of Rome, Rome, Italy
| | - Pasquale Berloco
- Department of General Surgery and Organ Transplantation, "Sapienza" University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
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Bacalbasa N, Balescu I, Diaconu C, Iliescu L, Filipescu A, Pop C, Dima S, Vilcu M, Brezean I. Right Upper Abdominal Resections in Advanced Stage Ovarian Cancer. In Vivo 2020; 34:1487-1492. [PMID: 32354951 DOI: 10.21873/invivo.11934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The right upper abdominal involvement is frequently encountered in patients with advanced stage ovarian cancer. The aim of this paper is to study the safety and efficacy of extended resections at this level as well as to determine the sites of residual disease. PATIENTS AND METHODS Between January 2016 and December 2019, 26 patients submitted to right upper abdominal resections were identified. RESULTS Peritoneal stripping and full thickness resections were the most commonly performed resections (in 57% and 19% of cases, respectively), followed by capsular liver resection and atypical liver resection (in 30% and 23% of cases, respectively) while the most common sites where resection was incomplete were the liver pedicle and porta hepatis. Exceptionally, one case necessitated performing a pancreatoduodenectomy as part of debulking surgery. Postoperatively, two cases developed serious complications and required reintervention; however, the overall mortality was null. CONCLUSION Right upper abdominal resections seem to be feasible and effective in order to maximize the debulking effort with acceptable risks arising from perioperative complications.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania .,Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Diaconu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital, Bucharest, Romania
| | - Laura Iliescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Cora Pop
- Department of Internal Medicine, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Simona Dima
- Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Mihaela Vilcu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Iulian Brezean
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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