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Liu T, Gao Y, Li S, Xu S. Exploration and prognostic analysis of two types of high-risk ovarian cancers: clear cell vs. serous carcinoma: a population-based study. J Ovarian Res 2024; 17:119. [PMID: 38824600 PMCID: PMC11143660 DOI: 10.1186/s13048-024-01435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/09/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Ovarian clear cell carcinoma (OCCC) is a rare pathological histotype in ovarian cancer, while the survival rate of advanced OCCC (Stage III-IV) is substantially lower than that of the advanced serous ovarian cancer (OSC), which is the most common histotype. The goal of this study was to identify high-risk OCCC by comparing OSC and OCCC, with investigating potential risk and prognosis markers. METHODS Patients diagnosed with ovarian cancer from 2009 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) Program. Logistic and Cox regression models were used to identify risk and prognostic factors in high-risk OCCC patients. Cancer-specific survival (CSS) and overall survival (OS) were assessed using Kaplan-Meier curves. Furthermore, Cox analysis was employed to build a nomogram model. The performance evaluation results were displayed using the C-index, calibration plots, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Immunohistochemically approach was used to identify the expression of the novel target (GPC3). RESULTS In the Cox analysis for advanced OCCC, age (45-65 years), tumor numbers (total number of in situ/malignant tumors for patient), T3-stage, bilateral tumors, and liver metastases could be defined as prognostic variables. Nomogram showed good predictive power and clinical practicality. Compared with OSC, liver metastases had a stronger impact on the prognosis of patients with OCCC. T3-stage, positive distant lymph nodes metastases, and lung metastases were risk factors for developing liver metastases. Chemotherapy was an independent prognostic factor for patient with advanced OCCC, but had no effect on CSS in patients with liver metastases (p = 0.0656), while surgery was significantly related with better CSS in these patients (p < 0.0001) (p = 0.0041). GPC3 expression was detected in all tissue sections, and GPC3 staining was predominantly found in the cytoplasm and membranes. CONCLUSION Advanced OCCC and OCCC with liver metastases are two types of high-risk OCCC. The constructed nomogram exhibited a satisfactory survival prediction for patients with advanced OCCC. GPC3 immunohistochemistry is expected to accumulate preclinical evidence to support the inclusion of GPC3 in OCCC targeted therapy.
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Affiliation(s)
- Tingwei Liu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yueqing Gao
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuangdi Li
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Shaohua Xu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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2
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Gaba F, Blyuss O, Chandrasekaran D, Bizzarri N, Refky B, Barton D, Ind T, Nobbenhuis M, Butler J, Heath O, Jeyarajah A, Brockbank E, Lawrence A, Manchanda R, Dilley J, Phadnis S. Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3484. [PMID: 37998621 PMCID: PMC10670762 DOI: 10.3390/diagnostics13223484] [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: 09/06/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
For women achieving clinical remission after the completion of initial treatment for epithelial ovarian cancer, 80% with advanced-stage disease will develop recurrence. However, the standard treatment of women with recurrent platinum-sensitive diseases remains poorly defined. Secondary (SCS), tertiary (TCS) or quaternary (QCS) cytoreduction surgery for recurrence has been suggested to be associated with increased overall survival (OS). We searched five databases for studies reporting death rate, OS, cytoreduction rates, post-operative morbidity/mortality and diagnostic models predicting complete cytoreduction in a platinum-sensitive disease recurrence setting. Death rates calculated from raw data were pooled based on a random-effects model. Meta-regression/linear regression was performed to explore the role of complete or optimal cytoreduction as a moderator. Pooled death rates were 45%, 51%, 66% for SCS, TCS and QCS, respectively. Median OS for optimal cytoreduction ranged from 16-91, 24-99 and 39-135 months for SCS, TCS and QCS, respectively. Every 10% increase in complete cytoreduction rates at SCS corresponds to a 7% increase in median OS. Complete cytoreduction rates ranged from 9-100%, 35-90% and 33-100% for SCS, TCS and QCS, respectively. Major post-operative thirty-day morbidity was reported to range from 0-47%, 13-33% and 15-29% for SCS, TCS and QCS, respectively. Thirty-day post-operative mortality was 0-6%, 0-3% and 0-2% for SCS, TCS and QCS, respectively. There were two externally validated diagnostic models predicting complete cytoreduction at SCS, but none for TCS and QCS. In conclusion, our data confirm that maximal effort higher order cytoreductive surgery resulting in complete cytoreduction can improve survival.
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Affiliation(s)
- Faiza Gaba
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Oleg Blyuss
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child’s Health, Sechenov University, 119435 Moscow, Russia
| | - Dhivya Chandrasekaran
- Department of Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Basel Refky
- Department of Surgical Oncology, Mansoura University, El Mansoura 7650030, Egypt
| | - Desmond Barton
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Thomas Ind
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Marielle Nobbenhuis
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - John Butler
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Owen Heath
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Arjun Jeyarajah
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Elly Brockbank
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Alexandra Lawrence
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - James Dilley
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Saurabh Phadnis
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
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3
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Hiu S, Bryant A, Gajjar K, Kunonga PT, Naik R. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2022; 8:CD007697. [PMID: 36041232 PMCID: PMC9427128 DOI: 10.1002/14651858.cd007697.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Ovarian cancer is the seventh most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. OBJECTIVES To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced-stage epithelial ovarian cancer. SEARCH METHODS We searched CENTRAL (2021, Issue 11), MEDLINE Ovid and Embase Ovid up to November 2021. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) or non-randomised studies (NRS), analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in women with advanced primary epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. We identified three NRS and conducted meta-analyses where possible. MAIN RESULTS We identified three retrospective observational studies for inclusion in the review. Two studies included women exclusively undergoing upfront primary debulking surgery (PDS) and the other study including both PDS and interval debulking surgical (IDS) procedures. All studies were at critical risk of bias due to retrospective and non-randomised study designs. Meta-analysis of two studies, assessing 397 participants, found that women who underwent radical procedures, as part of PDS, may have a lower risk of mortality compared to women who underwent standard surgery (adjusted HR 0.60, 95% CI 0.43 to 0.82; I2 = 0%; very low-certainty evidence), but the evidence is very uncertain. The results were robust to a sensitivity analysis including women with more-extensive disease (carcinomatosis) (adjusted HR 0.61, 95% CI 0.44 to 0.85; I2 = 0%; n = 283, very low-certainty evidence), but the evidence is very uncertain. One study reported a comparison of radical versus standard surgical procedures associated with both PDS and IDS procedures, but a multivariate analysis was only undertaken for disease-free survival (DFS) and therefore the certainty of the evidence was not assessable for overall survival (OS) and remains very low. The lack of reporting of OS meant the study was at high risk of bias for selective reporting of outcomes. One study, 203 participants, found that women who underwent radical procedures as part of PDS may have a lower risk of disease progression or death compared to women who underwent standard surgery (adjusted HR 0.62, 95% CI 0.42 to 0.92; very low-certainty evidence), but the evidence is very uncertain. The results were robust to a sensitivity analysis in one study including women with carcinomatosis (adjusted HR 0.52, 95% CI 0.33 to 0.82; n = 139; very low-certainty evidence), but the evidence is very uncertain. A combined analysis in one study found that women who underwent radical procedures (using both PDS and IDS) may have an increased chance of disease progression or death than those who received standard surgery (adjusted HR 1.60, 95% CI 1.11 to 2.31; I2 = 0%; n = 527; very low-certainty evidence), but the evidence is very uncertain. In absolute and unadjusted terms, the DFS was 19.3 months in the standard surgery group, 15.8 in the PDS group and 15.9 months in the IDS group. All studies were at critical risk of bias and we only identified very low-certainty evidence for all outcomes reported in the review. Perioperative mortality, adverse events and quality of life (QoL) outcomes were either not reported or inadequately reported in the included studies. Two studies reported perioperative mortality (death within 30 days of surgery), but they did not use any statistical adjustment. In total, there were only four deaths within 30 days of surgery in both studies. All were observed in the standard surgery group, but we did not report a risk ratio (RR) to avoid potentially misleading results with so few deaths and very low-certainty evidence. Similarly, one study reported postoperative morbidity, but the authors did not use any statistical adjustment. Postoperative morbidity occurred more commonly in women who received ultra-radical surgery compared to standard surgery, but the certainty of the evidence was very low. AUTHORS' CONCLUSIONS We found only very low-certainty evidence comparing ultra-radical surgery and standard surgery in women with advanced ovarian cancer. The evidence was limited to retrospective, NRSs and so is at critical risk of bias. The results may suggest that ultra-radical surgery could result in improved OS, but results are based on very few women who were chosen to undergo each intervention, rather than a randomised study and intention-to-treat analysis, and so the evidence is very uncertain. Results for progression/DFS were inconsistent and evidence was sparse. QoL and morbidity was incompletely or not reported in the three included studies. A separate prognostic review assessing residual disease as a prognostic factor in this area has been addressed elsewhere, which demonstrates the prognostic effect of macroscopic debulking to no macroscopic residual disease. In order to aid existing guidelines, the role of ultra-radical surgery in the management of advanced-stage ovarian cancer could be addressed through the conduct of a sufficiently powered, RCT comparing ultra-radical and standard surgery, or well-designed NRSs, if this is not possible.
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Affiliation(s)
- Shaun Hiu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
| | - Patience T Kunonga
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Raj Naik
- Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, UK
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4
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Baek MH, Park EY, Ha HI, Park SY, Lim MC, Fotopoulou C, Bristow RE. Secondary Cytoreductive Surgery in Platinum-Sensitive Recurrent Ovarian Cancer: A Meta-Analysis. J Clin Oncol 2022; 40:1659-1670. [PMID: 35188810 DOI: 10.1200/jco.21.02085] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The survival impact of secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer was studied. METHODS We identified published studies from 1983 to 2021 following our inclusion criteria from MEDLINE, EMBASE, and Cochrane library. To integrate the effect size of single-arm studies, meta-analysis was performed using death rate as a primary outcome. The effect of complete cytoreduction and optimal cytoreduction on survival was evaluated using meta-regression. The pooled death rate was presented with a 95% CI. The publication bias was evaluated with the funnel plot and Egger's test, and sensitivity analysis was performed. To overcome missing death rates, the linear regression model was performed on log-transformed median overall survival (OS) time using study size as a weight. RESULTS Thirty-six studies with 2,805 patients reporting death rates were used for this meta-analysis of the 80 eligible studies. There was strong heterogeneity, with the P value of the Cochrane Q test of < 0.0001 and Higgins's I2 statistics of 86%; thus, we considered a random effect model. The pooled death rate was 44.2% (95% CI, 39.0 to 49.5), and both the complete and optimal cytoreductions were associated with better survival outcomes as significant moderators in the meta-regression model (P < .001 and P = .005, respectively). Although 14 studies were located outside the funnel plot, Egger's test indicated no publication bias (P = .327). A sensitivity analysis excluding 14 studies showed similar results. In the linear regression model on the basis of 57 studies, the median OS time increased by 8.97% and 7.04% when the complete and optimal cytoreduction proportion increased by 10%, respectively, after adjusting other variables. CONCLUSION Secondary cytoreductive surgery, resulting in maximal tumor resection, significantly prolongs OS in platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Min-Hyun Baek
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, South Korea.,Department of Statistics and Data Science, Yonsei University, Seoul, South Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea.,Rare & Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, South Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Christina Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - Robert E Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA
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5
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Harrison R, Zighelboim I, Cloven NG, Marcus JZ, Coleman RL, Karam A. Secondary cytoreductive surgery for recurrent ovarian cancer: An SGO clinical practice statement. Gynecol Oncol 2021; 163:448-452. [PMID: 34686355 DOI: 10.1016/j.ygyno.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- R Harrison
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Zighelboim
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - N G Cloven
- Gynecologist Oncologist, Texas Oncology, Fort Worth Cancer Center, Fort Worth, TX, USA
| | - J Z Marcus
- Rutgers, New Jersey Medical School, Department of Obstetrics, Gynecology and Reproductive Health, Newark, NJ, USA
| | - R L Coleman
- Gynecologic Oncology, US Oncology & US Oncology Research, The Woodlands, TX, USA
| | - A Karam
- Stanford School of Medicine, Stanford, CA, USA.
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6
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Adamopoulou K, Gkamprana AM, Patsouras K, Halkia E. Addressing hepatic metastases in ovarian cancer: Recent advances in treatment algorithms and the need for a multidisciplinary approach. World J Hepatol 2021; 13:1122-1131. [PMID: 34630879 PMCID: PMC8473491 DOI: 10.4254/wjh.v13.i9.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023] Open
Abstract
The lifetime risk for ovarian cancer incidence is 1.39% and the lifetime risk of death is 1.04%. Most ovarian cancer patients are diagnosed at advanced stages (III, IV) because there were no specific symptoms or existing screening tests. Liver metastases have been found in up to 50% of patients dying of advanced ovarian cancer. Recent studies indicate the need for a multidisciplinary approach from initial diagnosis to oncologic surgery and chemotherapy treatment, mandating the involvement of gynecologic oncologists, surgical oncologist, medical oncologists, hepatobiliary surgeons, and interventional radiologists.
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Affiliation(s)
| | - Athanasia M Gkamprana
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, Pireaus 18536, Greece
| | - Konstantinos Patsouras
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, Pireaus 18536, Greece
| | - Evgenia Halkia
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, Pireaus 18536, Greece
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7
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Tanaka K, Shimada Y, Nishino K, Yoshihara K, Nakano M, Kameyama H, Enomoto T, Wakai T. Clinical Significance of Mesenteric Lymph Node Involvement in the Pattern of Liver Metastasis in Patients with Ovarian Cancer. Ann Surg Oncol 2021; 28:7606-7613. [PMID: 33821347 DOI: 10.1245/s10434-021-09899-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mesenteric lymph node (MLN) involvement is often observed in ovarian cancer (OC) with rectosigmoid invasion. This study aimed to investigate the clinical significance of MLN involvement in the pattern of liver metastasis in patients with OC. METHODS We included 85 stage II-IV OC patients who underwent primary or interval debulking surgery. Twenty-seven patients underwent rectosigmoid resection, whose status of MLN involvement was judged from hematoxylin and eosin (H&E) staining of resected specimens. The prognostic significance of clinicopathological characteristics, including MLN involvement, was evaluated using univariate and multivariate analyses. RESULTS MLN involvement was detected in 14/85 patients with stage II-IV OC. Residual tumor status, cytology of ascites, and MLN involvement were independent prognostic factors for progression-free survival (PFS; p = 0.033, p = 0.014, and p = 0.008, respectively). When patients were classified into three groups (no MLN, one MLN, two or more MLNs), the number of MLNs involved corresponded to three distinct groups in PFS (p = 0.001). The 3-year cumulative incidence of liver metastasis of patients with MLN involvement was significantly higher than that of patients without MLN involvement (61.1% vs. 8.9%, p < 0.001). MLN involvement was significantly associated with liver metastasis of hematogenous origin (p < 0.001) compared with peritoneal disseminated origin. CONCLUSION MLN involvement is an important prognostic factor in OC, predicting poor prognosis and liver metastasis of hematogenous origin.
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Affiliation(s)
- Kana Tanaka
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Koji Nishino
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masato Nakano
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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8
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Deng H, Zhu HL, Li Y, Wang Y, Wu Y, Cui H, Wang JL, Li XP. Treatment of liver metastases in patients with epithelial ovarian cancer. Chin Med J (Engl) 2021; 134:1236-1238. [PMID: 33410622 PMCID: PMC8143738 DOI: 10.1097/cm9.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Hao Deng
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
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9
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Abstract
This article addresses the role of surgery in the management of gynecologic cancers with liver metastases. The authors review the short-term and long-term outcomes of aggressive resection through retrospective and randomized studies. Although the data supporting aggressive resection of liver metastasis are largely retrospective and case based, the randomized control data to address neoadjuvant versus chemotherapy have been widely criticized. Residual disease remains an important predictor for survival in ovarian cancer. If a patient cannot achieve near optimal cytoreduction, radical cytoreductive procedures, such as hepatic resection, should be considered for palliation only.
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Affiliation(s)
- Kiran H Clair
- Division of Gynecologic Oncology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA.
| | - Juliet Wolford
- Division of Gynecologic Oncology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
| | - Jason A Zell
- Division of Hematology/Oncology, Department of Medicine, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
| | - Robert E Bristow
- Department of Obstetrics and Gynecology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
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10
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Yamamoto M, Yoshida M, Furuse J, Sano K, Ohtsuka M, Yamashita S, Beppu T, Iwashita Y, Wada K, Nakajima TE, Sakamoto K, Hayano K, Mori Y, Asai K, Matsuyama R, Hirashita T, Hibi T, Sakai N, Tabata T, Kawakami H, Takeda H, Mizukami T, Ozaka M, Ueno M, Naito Y, Okano N, Ueno T, Hijioka S, Shikata S, Ukai T, Strasberg S, Sarr MG, Jagannath P, Hwang TL, Han HS, Yoon YS, Wang HJ, Luo SC, Adam R, Gimenez M, Scatton O, Oh DY, Takada T. Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:1-25. [PMID: 33200538 DOI: 10.1002/jhbp.868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato-Biliary-Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. METHODS Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. CONCLUSIONS These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher-quality evidence.
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Affiliation(s)
- Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.,Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokoama, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Nozomu Sakai
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hiroyuki Takeda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Ueno
- Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoichi Naito
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tomohiko Ukai
- Division of Public Health, Osaka Institute of Public Health, Higashinari, Japan
| | - Steven Strasberg
- Section of HPB Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Tsann-Long Hwang
- Division of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Shao-Ciao Luo
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - René Adam
- AP HP Paul Brousse Hospital, University Paris Sud, Villejuif, France
| | - Mariano Gimenez
- Docencia Asistencia Investigación en Cirugía Invasiva Mínima Foundation, General and Minimally Invasive Surgery, University of Buenos Aires, Viamonte, Argentina.,Institute of Image-Guided Surgery, Strasbourg, France
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, APHP Pitié-Salpêtrière Hospital, Sorbonne Université, CRSA, Paris, France
| | - Do-Youn Oh
- Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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11
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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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12
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Luna-Abanto J, García Ruiz L, Laura Martinez J, Álvarez Larraondo M, Villoslada Terrones V. Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer. J Gynecol Surg 2020; 36:70-75. [PMID: 32292262 PMCID: PMC7153635 DOI: 10.1089/gyn.2019.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: The aim of this study was to describe and evaluate the safety of hepatic resections for ovarian cancer liver metastases and the benefit in terms of survival as part of cytoreductive surgery among peritoneal seeding and parenchymal metastases. Materials and Methods: Data were reviewed retrospectively from patients who underwent liver resection as part of cytoreductive surgery for ovarian cancer at the Instituto Nacional de Enfermedades Neoplásicas, in Lima, Perú, from January 2009 to December 2017. Results: From January 2009 to December 2017, 1211 patients underwent surgical cytoreduction for ovarian cancer; 39 of these patients had liver resection as part of their surgical treatment, with 9, 17, and 13 patients receiving primary, secondary, and tertiary, resections, respectively. The mean age of the patients was 46, the majority (87%) had stage III/IV ovarian cancer. In addition, 21 patients had parenchymal metastasis resections, and 95% of the patients had Dindo–Clavien I and II grade complications. The 30-day mortality rate was 0. Conclusions: Liver resection for advanced ovarian cancer is a safe procedure for primary up to quaternary cytoreduction and may confer survival benefits to patients.
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Affiliation(s)
- Jorge Luna-Abanto
- Department of Surgical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Luis García Ruiz
- Department of Surgical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Jheff Laura Martinez
- Department of Surgical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | | | - Vladimir Villoslada Terrones
- Department of Gynecology Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú.,School of Human Medicine, National University of Cajamarca, Cajamarca, Perú
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13
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Gallotta V, Conte C, D’Indinosante M, Capoluongo E, Minucci A, De Rose AM, Ardito F, Giuliante F, Di Giorgio A, Zannoni GF, Fagotti A, Margreiter C, Scambia G, Ferrandina G. Prognostic factors value of germline and somatic brca in patients undergoing surgery for recurrent ovarian cancer with liver metastases. Eur J Surg Oncol 2019; 45:2096-2102. [DOI: 10.1016/j.ejso.2019.06.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022] Open
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14
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Mouli SK, Gupta R, Sheth N, Gordon AC, Lewandowski RJ. Locoregional Therapies for the Treatment of Hepatic Metastases from Breast and Gynecologic Cancers. Semin Intervent Radiol 2018; 35:29-34. [PMID: 29628613 DOI: 10.1055/s-0038-1636518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies.
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Affiliation(s)
- Samdeep K Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ramona Gupta
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Neil Sheth
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Andrew C Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
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15
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Takemura N, Saiura A. Role of surgical resection for non-colorectal non-neuroendocrine liver metastases. World J Hepatol 2017; 9:242-251. [PMID: 28261381 PMCID: PMC5316844 DOI: 10.4254/wjh.v9.i5.242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/12/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
It is widely accepted that the indications for hepatectomy in colorectal cancer liver metastases and liver metastases of neuro-endocrine tumors result in relatively better prognoses, whereas, the indications and prognoses of hepatectomy for non-colorectal non-neuroendocrine liver metastases (NCNNLM) remain controversial owing to the limited number of cases and the heterogeneity of the primary diseases. There have been many publications on NCNNLM; however, its background heterogeneity makes it difficult to reach a specific conclusion. This heterogeneous disease group should be discussed in the order from its general to specific aspect. The present review paper describes the general prognosis and risk factors associated with NCNNLM while specifically focusing on the liver metastases of each primary disease. A multidisciplinary approach that takes into consideration appropriate timing for hepatectomy combined with chemotherapy may prolong survival and/or contribute to the improvement of the quality of life while giving respite from systemic chemotherapy.
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16
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Tozzi R, Traill Z, Garruto Campanile R, Ferrari F, Soleymani Majd H, Nieuwstad J, Hardern K, Gubbala K. Porta hepatis peritonectomy and hepato-celiac lymphadenectomy in patients with stage IIIC-IV ovarian cancer: Diagnostic pathway, surgical technique and outcomes. Gynecol Oncol 2016; 143:35-39. [PMID: 27519966 DOI: 10.1016/j.ygyno.2016.08.232] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/31/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report the surgical technique of ovarian cancer resection at the porta hepatis (PH) and hepato-celiac lymph nodes (HCL). To assess surgical and survival outcomes. Define the accuracy of an integrated diagnostic pathway. METHODS Patients with FIGO stage IIIC-IV ovarian cancer that underwent Visceral-Peritoneal Debulking (VPD). Data of patients with disease at the PH/HCL during VPD were extracted from our database. The CT scan findings were compared with the exploratory laparoscopy. Accuracy of CT scan, intra- and post-operative morbidity, rate of complete resection (CR), disease free and overall survival are reported. RESULTS Thirty one patients out of 216 (14.3%) had tumor at the PH and/or HCL. In 8 patients out of 31 (25.8%) it was only found with the aid of the exploratory laparoscopy. CR was achieved in 28 patients out of 31 (90.3%). Pathology confirmed disease in the PH/HCL specimens of all but one patient. Overall morbidity relating to the VPD was 29.2%. No complication was specifically related to the PH/HCL. Median disease free survival was 19months and median overall survival was 42months. CONCLUSION PH/HCL surgery was required in 15% of patients with FIGO stage IIIC-IV. The surgery was feasible, safe and significantly contributed to CR. CT scan failed to identify the disease in 31% of the patients. CT and laparoscopy correctly identified all patients.
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Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Zoe Traill
- Department of Radiology, Oxford University Hospital, Oxford, UK
| | | | - Federico Ferrari
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | | | - Joost Nieuwstad
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Kieran Hardern
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
| | - Kumar Gubbala
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
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Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:7. [PMID: 27330821 PMCID: PMC4912748 DOI: 10.1186/s40661-016-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
Background The management of patients with recurrent gynecological malignancy is complex, and often contentious. While historically, patients with metastases in the lungs, liver or brain have been treated with palliative intent, surgery is proving to have an increasing role in the management of such patients. Methods In this review article, the surgical management of lung, liver and brain metastases from gynecological cancers is examined. A search of the English language literature over the last 25 years was conducted using the Medline and PubMed databases. Results The results for management of metastases from the endometrium, ovary and cervix to the lung, brain and liver show that surprisingly good long-term survival results can be achieved for resection of metastases from all three organs. Patient selection is critical, and surgery is often used in conjunction with other treatment modalities. Conclusions From this review, it is apparent that surgery should play an increasing role in the management of patients with parenchymal metastases from gynecological cancers. The surgery should ideally be performed in high volume, tertiary centers where there is a committed multi-disciplinary team with the necessary infrastructure to achieve the best possible outcomes in terms of both survival and morbidity.
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18
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Hepatic resection during cytoreductive surgery for primary or recurrent epithelial ovarian cancer. J Cancer Res Clin Oncol 2015; 142:1509-20. [PMID: 26660323 DOI: 10.1007/s00432-015-2090-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/30/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Surgical cytoreduction remains a cornerstone in the management of patients with advanced and recurrent epithelial ovarian cancer. Parenchymal liver metastases determine stage VI disease and are commonly considered a major limit in the achievement of an optimal cytoreduction. The purpose of this manuscript was to discuss the rationale of liver resection and the morbidity related to this procedure in advanced and recurrent ovarian cancer. METHODS A search of the National Library of Medicine's MEDLINE/PubMed database until March 2015 was performed using the keywords: "ovarian cancer," "hepatic," "liver," and "metastases." RESULTS In patients with liver metastases, hepatic resection is associated with a similar prognosis as stage IIIC patients. The length of the disease-free interval between primary diagnosis and occurrence of liver metastases, as well as residual disease after resection, is the most important prognostic factors. In addition, the number of liver lesions, resection margins, and the gynecologic oncology group performance status seem to play also an important role in determining outcome. CONCLUSIONS In properly selected patients, liver resections at the time of cytoreduction increase rates of optimal cytoreduction and improve survival in advanced-stage and recurrent ovarian cancer patients.
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19
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Bhat RA, Chia YN, Lim YK, Yam KL, Lim C, Teo M. Survival Impact of Secondary Cytoreductive Surgery for Recurrent Ovarian Cancer in an Asian Population. Oman Med J 2015; 30:344-52. [PMID: 26421115 DOI: 10.5001/omj.2015.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the role of secondary cytoreductive surgery in Asian patients with recurrent ovarian cancer and to assess prognostic variables on overall post-recurrence survival time. METHODS We conducted a retrospective review of patients with recurrent ovarian cancer who underwent secondary cytoreduction at the Gynaecological Cancer Center at the KK Women's and Children's Hospital, Singapore, between 1999 and 2009. Eligible patients included those who had been firstly treated by primary cytoreductive surgery and followed by adjuvant chemotherapy and had a period of clinical remission of at least six months and subsequently underwent secondary cytoreductive surgery for recurrence. Univariate analysis was performed to evaluate various variables influencing the overall survival. RESULTS Twenty-five patients met our eligibility criteria. The median age was 52 years (range=31-78 years). The median time from completion of primary treatment to recurrence was 25.1 months (range=6.4-83.4). Secondary cytoreduction was optimal in 20 of 25 patients (80%). The median follow-up duration was 38.9 months (range=17.8-72.4) and median overall survival time was 33.1 months (95% confidence interval, 15.3-undefined.). Ten (40.0%) patients required bowel resection, but no end colostomy was performed. One (4.0%) patient had wedge resection of the liver, one (4.0%) had a distal pancreatectomy, one (4.0%) had a unilateral nephrectomy, and one (4.0%) had adrenalectomy. There were no operative deaths. The overall survival of patients who responded to secondary cytoreductive surgery and adjuvant chemotherapy was significantly longer than those patients who did not respond to the treatment. Of those patients who responded to the surgical management, patients with clear cell carcinoma fared well compared to those with the endometrioid, mucinous adenocarcinoma, and papillary serous type (p<0.001). Complete secondary cytoreductive surgery appeared to have some relationship to overall survival but was not statistically significant. CONCLUSION In carefully selected patients with recurrent ovarian cancer, optimal cytoreductive surgery is possible and in a subgroup of patients who respond to surgery and chemotherapy survival is significantly longer.
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Affiliation(s)
- Rani Akhil Bhat
- Department of Gynaecologic Oncology, BGS Global Hospitals, Bangalore, India
| | - Yin Nin Chia
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Yong Kuei Lim
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Kwai Lam Yam
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Cindy Lim
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Melissa Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
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20
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Liver metastases from non-gastrointestinal non-neuroendocrine tumours: review of the literature. Updates Surg 2015; 67:223-33. [PMID: 26341625 DOI: 10.1007/s13304-015-0315-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/21/2015] [Indexed: 12/23/2022]
Abstract
Liver resection is integrated in the oncological surgical management of metastatic gastrointestinal and neuroendocrine tumours. However, the good prognosis reached in these cases has not been obtained for metastatic tumours of other histological types. In this review, we analysed the published case reports and series of hepatectomies in patients with metastatic breast cancer, melanoma, sarcoma, genitourinary tumours, pulmonary and adrenocortical tumours. From the reported data the surgical resection of oligometastases yields good results in terms of improved survival, in particular when the disease-free time period is longer than 1 year. Hepatic resection can be a valid surgical strategy to obtain a survival benefit in patients with liver metastases from non-gastrointestinal, non-neuroendocrine tumours. However, a careful patient selection is needed in order to obtain a real survival benefit; patients with a good performance status, with a disease-free period longer than 1 year and with oligometastases may obtain the best advantage from this approach.
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21
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Bacalbasa N, Dima S, Brasoveanu V, David L, Balescu I, Purnichescu-Purtan R, Popescu I. Liver resection for ovarian cancer liver metastases as part of cytoreductive surgery is safe and may bring survival benefit. World J Surg Oncol 2015; 13:235. [PMID: 26243426 PMCID: PMC4524373 DOI: 10.1186/s12957-015-0652-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/14/2015] [Indexed: 02/08/2023] Open
Abstract
Background The aim of this study was to evaluate whether hepatic resections of ovarian cancer liver metastases provide a benefit in terms of survival as part of primary, secondary, tertiary, and even quaternary cytoreductive surgery. Methods Data of patients submitted to surgery for ovarian cancer liver metastases at Fundeni Clinical Institute between January 2002 and April 2014 were retrospectively reviewed. Liver lesions were classified according to their origin in parenchymal and peritoneal lesions. Results A total of 31 patients were identified: 11 of them underwent liver resection as part of primary cytoreduction, 15 at secondary cytoreduction, 3 at tertiary cytoreduction, and 2 at the time of quaternary cytoreduction. The survival of patients with primary cytoreduction including liver resection was significantly higher compared with that of patients with secondary cytoreductive surgery including liver resection (15.63 versus 6.63 months, log-rank p = 0.057, 90 % CI). The median survival of patients with hepatectomy for liver metastases from peritoneal seeding was higher than that of patients with hepatectomy for liver metastases from hematogenous origin (16.08 versus 12.66 months, log-rank p = 0.523). Conclusions Hepatectomy in ovarian cancer liver metastases is a safe and effective procedure; however, a benefit in terms of survival in favor of peritoneal seeding has been systematically observed.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, Bucharest, 050474, Romania.
| | - Simona Dima
- "Dan Setlacec" Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni 258, Bucharest, 022328, Romania.
| | - Vladislav Brasoveanu
- "Dan Setlacec" Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni 258, Bucharest, 022328, Romania.
| | - Leonard David
- "Dan Setlacec" Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni 258, Bucharest, 022328, Romania.
| | | | - Raluca Purnichescu-Purtan
- Department of Mathematical Methods and Models, Faculty of Applied Sciences, Politehnica University of Bucharest, Splaiul Independentei nr. 313, RO-060042, Bucharest, Romania.
| | - Irinel Popescu
- "Dan Setlacec" Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni 258, Bucharest, 022328, Romania.
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Benedetti Panici P, Di Donato V, Fischetti M, Casorelli A, Perniola G, Musella A, Marchetti C, Palaia I, Berloco P, Muzii L. Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: Analysis and management of complications in upper abdominal surgery. Gynecol Oncol 2015; 137:406-11. [DOI: 10.1016/j.ygyno.2015.03.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/22/2015] [Indexed: 12/17/2022]
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23
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The role of liver resection at the time of secondary cytoreduction in patients with recurrent ovarian cancer. Int J Gynecol Cancer 2014; 24:70-4. [PMID: 24356412 DOI: 10.1097/igc.0000000000000026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this study is to determine the role of liver metastatectomy in the morbidity and survival of patients with recurrent ovarian carcinoma. METHODS We retrospectively reviewed the records of all patients who had undergone hepatic resection for liver metastases from ovarian carcinoma at the time of cytoreductive surgery at our institution from 1988 to 2012. The Kaplan-Meier method was used for survival analysis. A total of 76 patients met the inclusion criteria and had undergone liver resection as part of cytoreductive surgery for ovarian carcinoma during the study period. Of these 76 patients, 27 underwent liver resection at the time of secondary cytoreduction, and these patients that are the focus of this analysis. RESULTS Median overall survival for the study group from the time of diagnosis to the last follow-up or death was 56 months (range, 12-249 months). Twenty died of the disease with an overall median survival of 12 months from the time of the liver resection (2-190 months), and 7 patients were alive with the disease at the time of the last follow-up. Based on Kaplan-Meier survival analysis, the factors associated with the longest survival after the liver resection (2-190 months) were the interval from the primary surgery of less than 24 months versus more than 24 months (P = 0.044) and secondary cytoreduction to residual disease of less than 1 cm (P = 0.014). CONCLUSIONS Based on our analysis of a single institution's series of ovarian cancer patients with hepatic metastasis, liver resection is feasible and safe and should be considered as an option in selected patients at the time of secondary cytoreduction.
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Fitzgerald TL, Brinkley J, Banks S, Vohra N, Englert ZP, Zervos EE. The benefits of liver resection for non-colorectal, non-neuroendocrine liver metastases: a systematic review. Langenbecks Arch Surg 2014; 399:989-1000. [PMID: 25148767 DOI: 10.1007/s00423-014-1241-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/11/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Defining the benefits of resection of isolated non-colorectal, non-neuroendocrine (NCRNNE) liver metastases is difficult. To better understand the survival benefit in this group of patients, we conducted a systematic review of the previous literature. METHODS Medline, Web of Knowledge, and manual searches were performed using search terms, such as "liver resection" and "primary tumor." Inclusion criteria were year>1990, >five patients, and median survival reported or derived. An expected median survival was calculated from weighted averages of median survivals, and differences were assessed using a permutation test. RESULTS A total of 7,857 references were identified. Overall 4,735 abstracts were reviewed; 120 manuscripts evaluated and of these, 73 met the study inclusion criteria. The final population consisted of 3,596 patients with renal (n=234), ovarian (n=119), testicular (n=153), adrenal (n=90), small bowel (n=28), gallbladder (n=21), duodenum (n=38), gastric (n=481), pancreatic (n=55), esophageal (n=23), head and neck (n=15), and lung (n=36) cancers, gastrointestinal stromal tumors (GISTs) (n=106), cholangiocarcinoma (n=13), sarcoma (n=189), and melanoma (n=643). The greatest expected median was 63 months for genitourinary (GU) primaries (n=549; range 5.4-142 months) followed by 44.4 months for breast cancer (n=1,013; range 8-74 months), 22.3 months for gastrointestinal cancer (n=549; range 5-58 months), and 23.7 months for other tumor types (n=1,082; range 10-72 months). Using a permutation test, we observed that survival was best for patients with GU primaries followed by that for breast cancer patients. Additionally, we also observed that survival was similar for those with cancer of the GI tract and other primary sites. CONCLUSIONS There appears to be a benefit to resection for patients with NCRNNE liver metastases. The degree of survival advantage is predicated by primary site.
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Affiliation(s)
- Timothy L Fitzgerald
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine, East Carolina University, 4S24 600 Moye Boulevard, Greenville, NC, 27834, USA,
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Diaphragmatic surgery during cytoreduction for primary or recurrent epithelial ovarian cancer: a review of the literature. Arch Gynecol Obstet 2013; 287:733-41. [PMID: 23341061 DOI: 10.1007/s00404-013-2715-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Surgical cytoreduction remains a cornerstone in the management of patients with advanced and recurrent epithelial ovarian cancer (EOC). Diaphragm involvement is a common site of metastases and represents a major limit in the achievement of an optimal cytoreduction. The purpose of this manuscript is to discuss the rationale of diaphragmatic surgery and the morbidity related to this procedure in advanced and recurrent EOC. METHODS A search of the National Library of Medicine's MEDLINE/PubMed database until August 2012 was performed using the keywords: 'diaphragmatic surgery' and 'ovarian cancer'. RESULTS Surgical treatment of diaphragmatic disease in advanced stage and recurrent EOC patients leads to high rates of optimal cytoreduction. It also correlates with an improved survival in advanced-stage EOC. The most common post-operative complication is a pleural effusion with rates ranging from 10 to 60 %. Pleural effusions are more common after diaphragmatic resections as compared to diaphragmatic stripping or coagulation. The need for post-operative thoracentesis or chest tube placement is low. The routine use of intraoperative trans-diaphragmatic decompression of pneumothorax reduces these rates. Diaphragmatic lesions at the time of interval debulking are less frequent and smaller in size. The morbidity of diaphragmatic surgery in this setting is lower as compared to a primary debulking; this is probably related to the fewer multivisceral radical procedures performed. CONCLUSIONS Diaphragmatic surgery at the time of cytoreduction increases rates of optimal cytoreduction and improves survival in advanced-stage and recurrent EOC patients. Gynecologic oncologists should be confident with its indication, technique and morbidity.
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Abstract
Ovarian cancer affects approximately 21,880 women and accounts for over 13,000 deaths annually in the United States. Although survival rates have improved over the past several decades, directly as a result of advances in chemotherapy and surgery, ovarian cancer continues to have high mortality rates. Understanding the multiple roles of surgery throughout the disease course is the focus of this review.
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Ramacciato G, D'Angelo F, Baldini R, Petrucciani N, Antolino L, Aurello P, Nigri G, Bellagamba R, Pezzoli F, Balesh A, Cucchetti A, Cescon M, Gaudio MD, Ravaioli M, Pinna AD. Hepatocellular Carcinomas and Primary Liver Tumors as Predictive Factors for Postoperative Mortality after Liver Resection: A Meta-Analysis of More than 35,000 Hepatic Resections. Am Surg 2012. [DOI: 10.1177/000313481207800438] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Liver resection is considered the therapeutic gold standard for primary and metastatic liver neoplasms. The reduction of postoperative complications and mortality has resulted in a more aggressive approach to hepatic malignancies. For the most part, results of liver surgery have been published by highly experienced institutions, but the observations of highly specialized units results may not reflect the current status of hepatic surgery, underestimating mortality and complications. The objective of this study is to evaluate morbidity and mortality as a result of liver resection for primary and metastatic lesions, analyzing a large number of studies with a meta-analytic process taking into account the overdispersion of data. An extensive literature search has been conducted, and 148 papers published between January 2000 and April 2008, including a total of 36,629 patients from both high-volume and low volume institutions, were included in the meta-analysis. A beta binomial model was used to provide a robust estimate of the summary event rate by pooling overdispersion binomial data from different studies. Overall morbidity and mortality after liver surgery were 29.32 per cent and 3.15 per cent, respectively. Significantly higher postoperative mortality was observed after liver resection for hepatocellular carcinomas and primary hepatic tumors. The application of a beta binomial model to correct for overdispersion of liver surgery data showed significantly higher postoperative mortality rates in patients with hepatocellular carcinomas or primary hepatic tumors after liver resection.
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Affiliation(s)
- Giovanni Ramacciato
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Francesco D'Angelo
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Rossella Baldini
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - NiccolÒ Petrucciani
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Laura Antolino
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Paolo Aurello
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Giuseppe Nigri
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Riccardo Bellagamba
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Francesca Pezzoli
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Albert Balesh
- Faculty of Medicine and Psychology St. Andrea Hospital, Hepato-biliary and Pancreatic Surgery
| | - Alessandro Cucchetti
- University of Bologna, Sant'Orsola-Malpighi Hospital, Liver and Multi-Organ Transplantation Unit, Bologna, Italy
| | - Matteo Cescon
- University of Bologna, Sant'Orsola-Malpighi Hospital, Liver and Multi-Organ Transplantation Unit, Bologna, Italy
| | - Massimo Del Gaudio
- University of Bologna, Sant'Orsola-Malpighi Hospital, Liver and Multi-Organ Transplantation Unit, Bologna, Italy
| | - Matteo Ravaioli
- University of Bologna, Sant'Orsola-Malpighi Hospital, Liver and Multi-Organ Transplantation Unit, Bologna, Italy
| | - Antonio Daniele Pinna
- University of Bologna, Sant'Orsola-Malpighi Hospital, Liver and Multi-Organ Transplantation Unit, Bologna, Italy
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Kamel SI, de Jong MC, Schulick RD, Diaz-Montes TP, Wolfgang CL, Hirose K, Edil BH, Choti MA, Anders RA, Pawlik TM. The role of liver-directed surgery in patients with hepatic metastasis from a gynecologic primary carcinoma. World J Surg 2011; 35:1345-54. [PMID: 21452068 DOI: 10.1007/s00268-011-1074-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. METHODS Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. RESULTS Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n=52), most underwent a minor hepatic resection (n=44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n=35) (p=0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. CONCLUSIONS Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.
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Affiliation(s)
- Sarah I Kamel
- Department of Surgery, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Ang C, Chan KKL, Bryant A, Naik R, Dickinson HO. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2011:CD007697. [PMID: 21491400 PMCID: PMC4028614 DOI: 10.1002/14651858.cd007697.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. OBJECTIVES To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer. SEARCH STRATEGY We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult women with advanced primary epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed. MAIN RESULTS One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 women with stage IIIC advanced epithelial ovarian cancer who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among women receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 women with carcinomatosis, those who underwent ultra-radical surgery had significantly better disease specific survival than women who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias. AUTHORS' CONCLUSIONS We found only low quality evidence comparing ultra-radical and standard surgery in women with advanced ovarian cancer and carcinomatosis. The evidence suggested that ultra-radical surgery may result in better survival. It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery.In order to determine the role of ultra-radical surgery in the management of advanced stage ovarian cancer, a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would be required.
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Affiliation(s)
- Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Karen K L Chan
- Gynaecological Oncology, Northern Gynaecological Oncology Centre, Tyne and Wear, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Heather O Dickinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Roh HJ, Kim DY, Joo WD, Yoo HJ, Kim JH, Kim YM, Kim YT, Nam JH. Hepatic resection as part of secondary cytoreductive surgery for recurrent ovarian cancer involving the liver. Arch Gynecol Obstet 2010; 284:1223-9. [PMID: 21132314 DOI: 10.1007/s00404-010-1750-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 10/22/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to assess the surgical outcomes and to also determine the prognostic factors in patients with surgically resectable liver metastases for recurrent ovarian cancer. METHODS Between 1991 and 2008, 18 patients with recurrent ovarian cancer who underwent hepatic resection as part of secondary cytoreductive surgery were identified from the tumor registry pathology database. Parameters for safety, efficacy, and survival data were considered as primary endpoints. RESULTS Hepatic resections included wedge resection (n = 4), unisegmentectomy (n = 13), and bisegmentectomy (n = 1). There were no surgery-related deaths. Only one patient (5.6%) had postoperative major complications. The median postoperative hospitalization was 15.5 days (range 11-46 days). The prognostic factors associated with improved survival were less abdominal than pelvic disease (38 vs. 11 months, P = 0.032), optimal cytoreduction (40 vs. 9 months, P = 0.0004), and negative margin status of the hepatic resection (40 vs. 9 months, P = 0.0196). The overall median survival after hepatic resection was 38 months (range 3-78 months). CONCLUSION Hepatic resection for recurrent ovarian cancer is safe and is associated with a favorable outcome. Parenchymal liver metastases should not exclude attempts at optimal secondary cytoreductive surgery, and especially, patients with solitary liver metastases should be considered for hepatic resection.
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Affiliation(s)
- Hyun-Jin Roh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Abstract
BACKGROUND The role of hepatic resection for gynaecological tumours is not well defined as evidence on the subject is lacking. This article describes a tertiary hepatopancreatobiliary unit's experience with hepatic resection for liver metastases from endometrioid primaries. METHODS Five women in whom liver metastases developed at 11 months to 10 years post-primary resection are presented. These patients subsequently underwent hepatic resection with disease-free survival of 8-66 months post-resection. RESULTS Outcomes in this patient series support hepatic resection in the face of isolated liver metastasis. CONCLUSIONS The authors advocate that patients with hepatic deposits should be referred to specialist hepatobiliary units with a view towards hepatic resection and a subsequent good outcome.
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Affiliation(s)
- Brett Knowles
- Departments of Surgery, Royal Infirmary of EdinburghEdinburgh, UK
| | | | - Anca Oniscu
- Departments of Pathology, Royal Infirmary of EdinburghEdinburgh, UK
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Fanfani F, Fagotti A, Gallotta V, Ercoli A, Pacelli F, Costantini B, Vizzielli G, Margariti PA, Garganese G, Scambia G. Upper abdominal surgery in advanced and recurrent ovarian cancer: Role of diaphragmatic surgery. Gynecol Oncol 2010; 116:497-501. [DOI: 10.1016/j.ygyno.2009.11.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/18/2009] [Accepted: 11/19/2009] [Indexed: 11/29/2022]
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Fagotti A, Gallotta V, Romano F, Fanfani F, Rossitto C, Vizzielli G, Costantini B, Scambia G. Role of cytoreductive surgery in recurrent ovarian cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/thy.09.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kommoss S, Rochon J, Harter P, Heitz F, Grabowski JP, Ewald-Riegler N, Haberstroh M, Neunhoeffer T, Barinoff J, Gomez R, Traut A, du Bois A. Prognostic impact of additional extended surgical procedures in advanced-stage primary ovarian cancer. Ann Surg Oncol 2009; 17:279-86. [PMID: 19898901 DOI: 10.1245/s10434-009-0787-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Treatment of advanced-stage ovarian carcinoma includes radical cytoreductive surgery, which aims at removing all visible tumor tissue followed by platinum and paclitaxel chemotherapy. Complete tumor resection may require extended surgical procedures. This paper reports on the prognostic impact of extensive surgery and surgical morbidity in patients with advanced-stage ovarian carcinoma. METHODS Patients with ovarian carcinoma [Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage IIIB-IV] undergoing primary surgery in our tertiary gynecologic oncology unit between 1997 and 2007 were eligible for this study. The impact of established prognostic factors and the interaction with extent of surgical procedures on survival were assessed. RESULTS A total of 267 patients aged between 29 and 88 years (median 64 years) were eligible for this study. Overall survival time was improved in patients who underwent complete tumor resection [hazard ratio (HR) 3.61 (1.91-6.61), P < 0.001]. No significant survival difference was observed between completely operated patients in whom extended or standard surgical procedures were applied [HR 1.37 (0.70-2.69), P = 0.358], and severe surgical complications were found to be equally distributed between the two patient groups. CONCLUSIONS Our results may encourage the application of extended surgical procedures in patients who would otherwise be rendered incompletely debulked after primary cytoreduction. We could demonstrate an impact of complete tumor resection on patient prognosis and this was not traded off for extensive additional surgical morbidity.
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Affiliation(s)
- S Kommoss
- Department of Gynecology and Gynecologic Oncology, Dr Horst Schmidt Klinik, Wiesbaden, Germany.
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Orezzoli JP, Wain JC, Fuller AF. Surgical management of the subdiaphragmatic mass: a sequential combined approach with laparoscopy followed by posterior thoracotomy. Int J Gynecol Cancer 2009; 19:294-9. [PMID: 19396012 DOI: 10.1111/igc.0b013e31819c13f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Recurrent ovarian cancer in the upper abdomen involving the liver parenchyma and diaphragmatic muscle traditionally requires a major abdominal surgical procedure; this involves pubis to xyphoid incision and complete mobilization of the liver. We present a strategy for evaluating 4 cases with apparently isolated recurrence to the diaphragm and liver approached by a sequential 2-phase procedure, involving diagnostic laparoscopy and subsequent posterior lateral thoracotomy. Preliminary diagnostic laparoscopy was performed to distinguish candidates for either definitive laparoscopic treatment or posterior thoracotomy. Two patients with disease confined to the diaphragm were successfully treated by laparoscopy alone, whereas full-thickness diaphragmatic resection and liver metastasis excision with cavitational ultrasonic surgical aspirator was performed in the other 2 patients. Argon beam coagulation was used to control local hemostasis and to fulgurate any possible residual tumor at the margin of resection. This is a multidisciplinary approach that is technically feasible and safe, requiring a short hospital stay.
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Affiliation(s)
- Jorge P Orezzoli
- Vincent Memorial Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Verleye L, Ottevanger P, van der Graaf W, Reed N, Vergote I. EORTC–GCG process quality indicators for ovarian cancer surgery. Eur J Cancer 2009; 45:517-26. [DOI: 10.1016/j.ejca.2008.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 09/13/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Aggressive and complex surgery for advanced ovarian cancer: An economic analysis. Gynecol Oncol 2009; 112:16-21. [DOI: 10.1016/j.ygyno.2008.10.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 10/06/2008] [Accepted: 10/08/2008] [Indexed: 11/22/2022]
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Lim MC, Kang S, Lee KS, Han SS, Park SJ, Seo SS, Park SY. The clinical significance of hepatic parenchymal metastasis in patients with primary epithelial ovarian cancer. Gynecol Oncol 2008; 112:28-34. [PMID: 19010521 DOI: 10.1016/j.ygyno.2008.09.046] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 09/23/2008] [Accepted: 09/24/2008] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The objective of this study was to determine the clinical significance of hepatic parenchymal metastasis on survival in patients with advanced epithelial ovarian cancer. METHODS We conducted a retrospective review of ovarian cancer patients with stages IIIc and IV hepatic parenchymal metastasis who were treated at the National Cancer Center in Korea between January 2001 and January 2008. Hepatic metastases were divided into unresectable, hematogenous parenchymal metastasis and resectable, parenchymal metastasis from peritoneal seeding. RESULTS One hundred twenty patients were identified, 113 of whom were included in the study. The stage IIIc group included 97 patients, and the group with stage IV disease and hepatic parenchymal metastasis included 16 patients. Of the 16 patients with hepatic parenchymal metastasis, 2 patients had unresectable, hematogenous parenchymal metastasis with a poor prognosis compared to the patients with resectable, hepatic parenchymal metastasis from peritoneal seeding. Fourteen patients with hepatic parenchymal metastases from peritoneal seeding underwent complete resection without complications as follows: wedge resection (n=7), segmentectomy (n=5), and hemi-hepatectomy (n=2). Age, tumor grade, histology, serum CA-125 level, and the rate of optimal debulking were similar in patients with stage IIIc disease and patients with stage IV disease who had resectable, hepatic parenchymal metastasis from peritoneal seeding. The 5-year progression free survival rate and the 5-year overall survival rate for patients with stage IIIc disease and patients with stage IV disease and hepatic parenchymal metastasis from peritoneal seeding were 25 and 23% (p=0.8063), and 55 and 51% (p=0.5671), respectively. CONCLUSION Our findings suggest that complete hepatic resection should be attempted for patients with hepatic parenchymal metastasis from peritoneal seeding.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
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Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 2008; 112:265-74. [PMID: 18937969 DOI: 10.1016/j.ygyno.2008.08.033] [Citation(s) in RCA: 234] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 08/22/2008] [Accepted: 08/23/2008] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the relative effect of multiple prognostic variables on overall post-recurrence survival time among cohorts of patients with recurrent ovarian cancer undergoing cytoreductive surgery. METHODS Forty cohorts of patients with recurrent ovarian cancer (2019 patients) meeting study inclusion criteria were identified from the MEDLINE database (1983-2007). Simple and multiple linear regression analyses, with weighted correlation calculations, were used to assess the effect on median post-recurrence survival time of the following variables: year of publication, age, disease-free interval, localized disease, tumor grade and histology, the proportion of patients undergoing complete cytoreductive surgery, requirement for bowel resection, and the sequence of cytoreductive surgery and salvage chemotherapy. RESULTS The mean weighted median disease-free interval prior to cytoreductive surgery was 20.2 months, and the mean weighted median overall post-recurrence survival time was 30.3 months. The weighted mean proportion of patients in each cohort undergoing complete cytoreductive surgery was 52.2%. Median survival improved with increasing year of publication (p=0.009); however, the only statistically significant clinical variable independently associated with post-recurrence survival time was the proportion of patients undergoing complete cytoreductive surgery (p=0.019). After controlling for all other factors, each 10% increase in the proportion of patients undergoing complete cytoreductive surgery was associated with a 3.0 month increase in median cohort survival time. CONCLUSIONS Among patients undergoing operative intervention for recurrent ovarian cancer, the proportion of patients undergoing complete cytoreductive surgery is independently associated with overall post-recurrence survival time. For this select group of patients, the surgical objective should be resection of all macroscopic disease.
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Di Giorgio A, Naticchioni E, Biacchi D, Sibio S, Accarpio F, Rocco M, Tarquini S, Di Seri M, Ciardi A, Montruccoli D, Sammartino P. Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer. Cancer 2008; 113:315-25. [PMID: 18473354 DOI: 10.1002/cncr.23553] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Because of scarce data from larger series and nonhomogeneous selection criteria, further information is needed on peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC) in managing patients with ovarian peritoneal carcinomatosis. METHODS In an open, prospective, single-center nonrandomized phase 2 study conducted from November 2000 to April 2007, 47 patients with primary advanced or recurrent ovarian cancer and diffuse peritoneal carcinomatosis were enrolled; 22 underwent primary and 25 secondary cytoreduction plus immediate HIPEC followed by systemic chemotherapy. RESULTS The overall mean Sugarbaker peritoneal cancer index was 14.9 (range, 6-28). A mean of 6 surgical procedures were required per patient (range, 4-10). In 87.3% of the patients debulking achieved optimal cytoreduction (Sugarbaker completeness of cytoreduction [CC] score 0-1), whereas in 12.7% it left macroscopic residual disease (CC-2 or CC-3). Major complications developed in 21.3% of the patients and the in-hospital mortality rate was 4.2%. The mean overall survival was 30.4 months, median survival was 24 months, and mean disease-free survival was 27.4 months. Five-year survival was 16.7%. Univariate (log-rank test and analysis of variance) and multivariate analyses (Cox proportional-hazard model) identified the CC score as the main factor capable of independently influencing survival. CONCLUSIONS Peritonectomy procedures combined with HIPEC offer promising long-term survival in patients with diffuse peritoneal ovarian carcinomatosis. They achieve high adequate primary and secondary surgical cytoreduction rates with acceptable morbidity and mortality.
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Affiliation(s)
- Angelo Di Giorgio
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Azienda Polyclinic Umberto I, Rome, Italy.
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Ovarian cancer in the octogenarian: Does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? Gynecol Oncol 2008; 110:133-9. [DOI: 10.1016/j.ygyno.2008.03.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 03/18/2008] [Accepted: 03/20/2008] [Indexed: 12/22/2022]
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Choi EA, Abdalla EK. Patient selection and outcome of hepatectomy for noncolorectal non-neuroendocrine liver metastases. Surg Oncol Clin N Am 2008; 16:557-77, ix. [PMID: 17606194 DOI: 10.1016/j.soc.2007.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Improved patient selection, introduction of more effective systemic treatments including targeted biologic and combined therapies, and the low morbidity and mortality rates of hepatobiliary surgery in centers of excellence are likely to provide continued improvements in outcomes for patients with noncolorectal non-neuroendocrine liver metastases. Further advances in treatment may emerge from better understanding of the underlying tumor biology for each cancer type and application of individualized care to each patient.
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Affiliation(s)
- Eugene A Choi
- The University of Texas M. D. Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA
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Dowdy SC, Loewen RT, Aletti G, Feitoza SS, Cliby W. Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma. Gynecol Oncol 2008; 109:303-7. [PMID: 18384866 DOI: 10.1016/j.ygyno.2008.02.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 02/07/2008] [Accepted: 02/14/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the technique of diaphragmatic peritonectomy (DP) for ovarian cancer cytoreduction and to assess associated morbidity. METHODS Retrospective review yielded 56 patients who underwent DP as part of a cytoreductive procedure for primary or recurrent ovarian cancer between 1988 and 2004. Patients who underwent diaphragmatic resection, removal of diaphragmatic implants with CUSA, cautery, curette, or finger fracture, and patients with pseudomyxoma were excluded from analysis. RESULTS DP was performed as a component of primary or secondary cytoreduction in 37 (66%) and 19 (34%) patients, respectively. Extended procedures including bowel resection, hepatic resection, splenectomy, or radical hysterectomy were performed with DP in 47 patients (82%). Resection of all disease >1 cm was achieved in 95% (microscopic residuum in 43%). For those undergoing primary cytoreduction, median survival was 59 months and 5-year survival was 49% with median follow-up of 34 months. When performed for recurrent ovarian carcinoma, 5-year survival was 16% and median survival was 23 months. No intra-operative complications could be specifically attributed to DP. Post-operative complications included a 30% rate of pleural effusion which was associated with entry into the pleural space during DP (p<0.0001); thoracentesis was required in 12.5%. CONCLUSIONS Diaphragmatic metastases are a common obstacle to optimal cytoreduction for patients with ovarian cancer. When necessary, utilizing DP in concert with other extended procedures to obtain maximal cytoreduction is associated with excellent survival. It should be recognized that DP is associated with an increased incidence of post-operative pleural effusion, particularly when the pleural space is entered.
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Affiliation(s)
- Sean C Dowdy
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Abood G, Bowen M, Potkul R, Aranha G, Shoup M. Hepatic resection for recurrent metastatic ovarian cancer. Am J Surg 2008; 195:370-3; discussion 373. [PMID: 18207130 DOI: 10.1016/j.amjsurg.2007.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 12/04/2007] [Accepted: 12/04/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role for liver resection in metastatic ovarian cancer has not been defined. The aim of the current study was to investigate the validity of hepatic resection as a treatment option in metastatic ovarian cancer. METHODS Retrospective review of a single institution's experience of patients undergoing hepatic resection for metastatic ovarian cancer from 1998-2006. RESULTS Ten patients underwent resection for metastatic ovarian cancer. Primary tumor type included serous cystadenocarcinoma (n = 8), granulosa cell (n = 1), and yolk sac (n = 1). Median disease-free interval was 48 months. Liver resections included trisegmentectomy (n = 4), lobectomy (n = 4), and bisegmentectomy(n = 1). Additional surgeries included diaphragm resection (n = 60), bowel resection, (n = 30), and adrenalectomy (n = 10). The median overall survival following liver resection was 33 months. CONCLUSION Liver resection for metastatic ovarian cancer is safe and is associated with long-term survival in some patients. Larger analysis may lead to the identification of prognostic factors associated with improved outcomes.
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Affiliation(s)
- Gerard Abood
- Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
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Goéré D, Elias D. Resection of liver metastases from non-colorectal non-endocrine primary tumours. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2007; 34:281-8. [PMID: 17933487 DOI: 10.1016/j.ejso.2007.07.205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 07/20/2007] [Indexed: 10/22/2022]
Abstract
Despite the greater number of hepatectomies for non-colorectal non-endocrine liver metastases, its benefits and its indications remain unclear because most of the patient series are small with heterogeneous primary tumours. After analyzing the literature including a large recent series (1451 patients), we can conclude that liver resection of non-colorectal non-endocrine metastases is feasible, safe, and improves survival. Better selection of patients according to their tumour biology (a long interval between the primary and liver metastases), the histologic type (non epithelial) and tumour chemosensitivity should improve long-term disease-free and overall survival, as we observed after resection of liver metastases from colorectal cancer.
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Affiliation(s)
- D Goéré
- Department of Surgical Oncology, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cedex, France.
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Aletti GD, Gallenberg MM, Cliby WA, Jatoi A, Hartmann LC. Current management strategies for ovarian cancer. Mayo Clin Proc 2007; 82:751-70. [PMID: 17550756 DOI: 10.4065/82.6.751] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epithelial ovarian cancer originates in the layer of cells that covers the surface of the ovaries. The disease spreads readily throughout the peritoneal cavity and to the lymphatics, often before causing symptoms. Of the cancers unique to women, ovarian cancer has the highest mortality rate. Most women are diagnosed as having advanced stage disease, and efforts to develop new screening approaches for ovarian cancer are a high priority. Optimal treatment of ovarian cancer begins with optimal cytoreductive surgery followed by combination chemotherapy. Ovarian cancer, even in advanced stages, is sensitive to a variety of chemotherapeutics. Although improved chemotherapy has increased 5-year survival rates, overall survival gains have been limited because of our inability to eradicate all disease. Technologic advances that allow us to examine the molecular machinery that drives ovarian cancer cells have helped to identify numerous therapeutic targets within these cells. In this review, we provide an overview of ovarian cancer with particular emphasis on recent advances in operative management and systemic therapies.
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Affiliation(s)
- Giovanni D Aletti
- Division of Gynecologic Surgery, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Abstract
PURPOSE OF REVIEW This review examines the current role of intestinal surgery in advanced ovarian cancer. Institutions differ considerably in surgical procedures and therapeutic outcomes for this disease. Moreover, therapeutic outcomes are influenced by the inclusion criteria for surgical procedures and the degree of surgical completion. We discuss the role of intestinal surgery and suggest surgical indications for intestinal surgery in advanced ovarian cancer. RECENT FINDINGS Prognosis in advanced ovarian cancer is better when there is a smaller postoperative tumor mass. However, it is necessary to investigate the effects of intestinal surgery on residual tumor mass and its prognostic benefits. Here, recent reports were reviewed to ascertain the usefulness and safety of intestinal surgery for advanced ovarian cancer and examine surgical indications and institutional requirements. SUMMARY By performing aggressive intestinal surgery such as combined bowel resection, optimal cytoreductive surgery can be performed in 70-98% of cases. The morbidity associated with intestinal surgery is acceptably low. Prognostic benefits for intestinal surgery are clear in patients with operable ovarian cancer with no residual disease. Women with suspected ovarian cancer should therefore be referred to centers with experienced tumor surgeons.
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Affiliation(s)
- Osamu Takahashi
- Department of Obstetrics and Gynecology, Akita City Hospital, Kawamoto, Akita, Japan.
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Aletti GD, Long HJ, Podratz KC, Cliby WA. Is time to chemotherapy a determinant of prognosis in advanced-stage ovarian cancer? Gynecol Oncol 2007; 104:212-6. [PMID: 17023033 DOI: 10.1016/j.ygyno.2006.07.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 07/19/2006] [Accepted: 07/31/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Clinicians often question when to start chemotherapy after patients undergo surgery for ovarian cancer. A major unproven concern is whether a long postoperative delay reduces the benefits of an extensive procedure and leads to disease progression. Our objectives were to evaluate the correlation between clinical and pathologic variables and to evaluate the effect of the "time to chemotherapy" (TTC) interval on survival. METHODS We retrospectively studied data from 218 patients with International Federation of Gynecology and Obstetrics stage IIIC or IV ovarian cancer (TNM stage T3c or T4) who were consecutively treated between January 1, 1994, and December 31, 1998. RESULTS Mean age at diagnosis was 64 years (range, 24-87 years; median, 65 years), and 206 patients received postoperative platinum-based chemotherapy. Mean TTC interval was 26 days (range, 7-79 days; median, 25 days). No correlation was found between operative time and TTC interval length (P=0.99). Age and performance of rectosigmoidectomy were correlated with longer TTC interval (P=0.009 and P=0.005, respectively), but TTC was not a predictor of overall survival (odds ratio, 1.00; 95% confidence interval, 0.98-1.01; P=0.85). Differences in TTC interval length (< or =17 days, 18-26 days, 27-33 days, or > or =34 days) did not affect survival (P=0.93). Even after categorizing patients by residual disease (<1 cm or > or =1 cm), no statistically significant effect of TTC on prognosis was identified. CONCLUSIONS Concerns about the TTC interval should not be used to justify spending less time in the operative arena or using a more conservative approach for patients with advanced ovarian cancer.
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Affiliation(s)
- Giovanni D Aletti
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Harter P, du Bois A. The role of surgery in ovarian cancer with special emphasis on cytoreductive surgery for recurrence. Curr Opin Oncol 2006; 17:505-14. [PMID: 16093804 DOI: 10.1097/01.cco.0000174166.06734.c7] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The role of cytoreductive surgery for recurrent ovarian cancer has not clearly been defined, and randomized trials are lacking. Some series have reported favorable outcomes for selected patients. This review summarizes the available evidence for selecting patients and the results of cytoreductive surgery in recurrent ovarian cancer. RECENT FINDINGS A Medline search identified 23 series including 1795 patients (21-285 patients per study). Patients who underwent cytoreductive surgery for recurrence were highly selected. Complete tumor resection was feasible in 9 to 82% of patients and was commonly associated with prolonged survival. A variety of predictive and prognostic factors for complete resection were reported. Good performance status, disease characteristics (e.g. peritoneal carcinosis), and outcome of prior surgery seemed to have an impact on surgical outcome. By contrast, disease-free survival played only a minor role, especially in patients with recurrence later than 6 months after primary treatment. SUMMARY Prospective evaluation of predictive scores for successful cytoreductive surgery in recurrent ovarian cancer is urgently needed. In a second step, randomized trials evaluating the role of surgery in the treatment strategy of recurrent ovarian cancer should be initiated. Until then, experienced and trained surgeons might offer surgery for recurrent disease to individually selected patients after giving information about the potential benefit and about the limited available evidence regarding this strategy.
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Affiliation(s)
- Philipp Harter
- Department of Gynaecology and Gynaecologic Oncology HSK, Dr. Horst Schmidt Klinik, Ludwig-Erhard-Strasse 100, D-65199 Wiesbaden, Germany.
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Bosquet JG, Merideth MA, Podratz KC, Nagorney DM. Hepatic resection for metachronous metastases from ovarian carcinoma. HPB (Oxford) 2006; 8:93-6. [PMID: 18333253 PMCID: PMC2131426 DOI: 10.1080/13651820500472119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recently, several authors have reported that optimal primary cytoreduction of both hepatic and extrahepatic disease is not only feasible but improves survival. However, the role of hepatic resection in combination with secondary cytoreduction for epithelial ovarian cancer is unclear. Patients with recurrent ovarian cancer and metachronous intrahepatic metastases are often evaluated by a multidisciplinary team at the Mayo Clinic comprising pelvic and hepatobiliary surgeons for consideration of cytoreductive surgery. The purpose of this report is to update the outcome of cytoreductive surgery including hepatic resection for patients with metastatic ovarian carcinoma.
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Affiliation(s)
| | - Melissa A. Merideth
- Division of Gastroenterologic and General Surgery, Mayo ClinicRochester MNUSA
| | - Karl C. Podratz
- Division of Gastroenterologic and General Surgery, Mayo ClinicRochester MNUSA
| | - David M. Nagorney
- Division of Gastroenterologic and General Surgery, Mayo ClinicRochester MNUSA
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