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Filippova OT, Boecking K, Broach V, Gardner GJ, Sonoda Y, Chi DS, Zivanovic O, Long Roche K. Trends in specific procedures performed at the time of cytoreduction for ovarian cancer: Is interval debulking surgery truly less radical? A Memorial Sloan Kettering Cancer Center Team Ovary study. Gynecol Oncol 2024; 187:80-84. [PMID: 38735143 DOI: 10.1016/j.ygyno.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES To evaluate procedures performed during primary debulking surgery (PDS) and interval debulking surgery (IDS) for ovarian cancer. METHODS Patients surgically treated at our institution for newly diagnosed stage IIIC/IV epithelial ovarian cancer between 6/1/2015-12/31/2021 were identified using a prospectively collected database. Patients were triaged to PDS or neoadjuvant chemotherapy (NACT) followed by IDS using an institutional algorithm. Data on specific procedures performed, including consultants called, were collected from operative and pathology reports. Appropriate statistical analyses were applied. RESULTS Overall, 467 patients underwent PDS and 434 underwent IDS; 76% (PDS) and 71% (IDS) of cases achieved complete gross resection. Comparing PDS vs IDS cohorts, median age was 63 years (range, 23-86) vs 67 years (range, 35-95), 79% vs 86% of patients had high-grade serous histology, and 38% vs 70% had stage IV disease. Most procedures (except ostomy, distal pancreatectomy) were more common during PDS (P < .05). Bowel surgery was performed during 65% of PDS and 33% of IDS, and upper abdominal surgery during 72% of PDS and 52% of IDS; both were more common during PDS (P < .001). Estimated blood loss (median, 500 mL [PDS] vs 300 mL [IDS]) and operative time (median, 362 min [PDS] vs 267 min [IDS]) were higher for PDS (P < .001). A consulting surgeon was utilized during 31% of PDS and 18% of IDS, with hepatopancreaticobiliary as the most commonly called service (61% and 65%, respectively). CONCLUSIONS In our study of patients with advanced-stage ovarian cancer, while most procedures were more often performed during PDS, NACT did not obviate the need for radical surgical resection. Thus, advanced surgical skills remain essential.
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Affiliation(s)
- Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Katherine Boecking
- Department of OB/GYN, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of OB/GYN, Weill Cornell Medical College, New York, NY, United States of America
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of OB/GYN, Weill Cornell Medical College, New York, NY, United States of America
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of OB/GYN, Weill Cornell Medical College, New York, NY, United States of America
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of OB/GYN, Weill Cornell Medical College, New York, NY, United States of America
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of OB/GYN, Weill Cornell Medical College, New York, NY, United States of America
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of OB/GYN, Weill Cornell Medical College, New York, NY, United States of America.
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Surgical Techniques and Outcomes of Colorectal Anastomosis after Left Hemicolectomy with Low Anterior Rectal Resection for Advanced Ovarian Cancer. Cancers (Basel) 2021; 13:cancers13164248. [PMID: 34439401 PMCID: PMC8393927 DOI: 10.3390/cancers13164248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Extended colon resection is often performed in advanced ovarian cancer. Restoring intestinal continuity and avoiding stoma creation improve patients' quality of life postoperatively. We tried to minimize the number of anastomoses, restore intestinal continuity, and avoid stoma creation for 295 patients with stage III/IV ovarian cancer who underwent low anterior rectal resection (LAR) with or without colon resection during cytoreductive surgery. When the remaining colon could not reach the rectal stump after left hemicolectomy with LAR, we used the following techniques for tension-free anastomosis: right colonic transposition, retro-ileal anastomosis through an ileal mesenteric defect, or an additional colic artery division. Rates of stoma creation and rectal anastomotic were 3% (9/295) and 6.6% (19/286), respectively. Among 21 patients in whom the remaining colon did not reach the rectal stump after left hemicolectomy with LAR, 20 underwent tension-free anastomosis, including eight, six, and six patients undergoing right colonic transposition, retro-ileal anastomosis through an ileal mesenteric defect, and an additional colic artery division, respectively. Colorectal anastomosis is feasible for patients with extended colonic resection. Low anastomotic leakage and stoma rates can be achieved with careful attention to colonic mobilization and tension-free anastomosis.
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Ehmann S, Aviki EM, Sonoda Y, Boerner T, Sassine D, Jones DR, Park B, Cohen M, Rosenblum NG, Chi DS. Diaphragm hernia after debulking surgery in patients with ovarian cancer. Gynecol Oncol Rep 2021; 36:100759. [PMID: 33869713 PMCID: PMC8042427 DOI: 10.1016/j.gore.2021.100759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
Over 80% of patients with epithelial ovarian cancer present with advanced disease, FIGO stage III or IV at the time of diagnosis. The majority require extensive upper abdominal surgery to obtain complete gross resection. This may include splenectomy, distal pancreatectomy, partial hepatectomy, cholecystectomy, and usually diaphragmatic peritonectomy or resection. Following surgery, diaphragmatic hernia-a very rare but serious complication-may occur. We describe four cases of left-sided diaphragmatic hernia resulting after debulking surgery, which included left diaphragm peritonectomy and splenectomy, in patients with advanced ovarian cancer. In association with the current shift towards more extensive debulking surgery for ovarian cancer, more patients may present with postoperative left-sided diaphragm hernia, making the prevention, diagnosis, and management of this complication important to practicing gynecologic oncologists. Intraoperatively the diaphragm should be checked thoroughly to rule out any defects, which should be closed. A diaphragmatic hernia may be easily misdiagnosed because the patient can present with various symptoms. While rare, these hernias require prompt identification, intervention and surgical correction to avoid serious complications.
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Affiliation(s)
- Sarah Ehmann
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline M. Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dib Sassine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R. Jones
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard Park
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Norman G. Rosenblum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
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Aggressive surgery could overcome the extent of initial peritoneal dissemination for advanced ovarian, fallopian tube, and peritoneal carcinoma. Sci Rep 2020; 10:21307. [PMID: 33277564 PMCID: PMC7718231 DOI: 10.1038/s41598-020-78296-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
We examined whether the extent of initial peritoneal dissemination affected the prognosis of patients with advanced ovarian, fallopian tube, and peritoneal carcinoma when initially disseminated lesions > 1 cm in diameter were removed, regardless of the timing of aggressive cytoreductive surgery. The extent of peritoneal dissemination was assessed by the peritoneal cancer index (PCI) at initial laparotomy in 186 consecutive patients with stage IIIC/IV. Sixty patients underwent primary debulking surgery and 109 patients underwent neoadjuvant chemotherapy followed by interval debulking surgery. Seventeen patients could not undergo debulking surgery because of disease progression during neoadjuvant chemotherapy. The median initial PCI were 17. Upper abdominal surgery and bowel resection were performed in 149 (80%) and 171 patients (92%), respectively. Residual disease ≤ 1 cm after surgery was achieved in 164 patients (89%). The initial PCI was not significantly associated with progression-free survival (PFS; p = 0.13) and overall survival (OS; p = 0.09). No residual disease and a high-complexity surgery significantly prolonged PFS (p < 0.01 and p = 0.02, respectively) and OS (p < 0.01 and p ≤ 0.01, respectively). The extent of initial peritoneal dissemination did not affect the prognosis when initially disseminated lesions > 1 cm were resected.
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Llueca A, Serra A, Climent MT, Segarra B, Maazouzi Y, Soriano M, Escrig J. Outcome quality standards in advanced ovarian cancer surgery. World J Surg Oncol 2020; 18:309. [PMID: 33239057 PMCID: PMC7690155 DOI: 10.1186/s12957-020-02064-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Advanced ovarian cancer surgery (AOCS) frequently results in serious postoperative complications. Because managing AOCS is difficult, some standards need to be established that allow surgeons to assess the quality of treatment provided and consider what aspects should improve. This study aimed to identify quality indicators (QIs) of clinical relevance and to establish their acceptable quality limits (i.e., standard) in AOCS. MATERIALS AND METHODS We performed a systematic search on clinical practice guidelines, consensus conferences, and reviews on the outcome and quality of AOCS to identify which QIs have clinical relevance in AOCS. We then searched the literature (from January 2006 to December 2018) for each QI in combination with the keywords of advanced ovarian cancer, surgery, outcome, and oncology. Standards for each QI were determined by statistical process control techniques. The acceptable quality limits for each QI were defined as being within the limits of the 99.8% interval, which indicated a favorable outcome. RESULTS A total of 38 studies were included. The QIs selected for AOCS were complete removal of the tumor upon visual inspection (complete cytoreductive surgery), a residual tumor of < 1 cm (optimal cytoreductive surgery), a residual tumor of > 1 cm (suboptimal cytoreductive surgery), major morbidity, and 5-year survival. The rates of complete cytoreductive surgery, optimal cytoreductive surgery, suboptimal cytoreductive surgery, morbidity, and 5-year survival had quality limits of < 27%, < 23%, > 39%, > 33%, and < 27%, respectively. CONCLUSION Our results provide a general view of clinical indicators for AOCS. Acceptable quality limits that can be considered as standards were established.
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Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain. .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain. .,Department of Medicine, University Jaume I (UJI), Castellón, Spain.
| | - Anna Serra
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellón, Spain
| | - Maria Teresa Climent
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellón, Spain
| | - Blanca Segarra
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | - Yasmine Maazouzi
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | - Marta Soriano
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Anesthesiology, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain.,Department of Medicine, University Jaume I (UJI), Castellón, Spain.,Department of General Surgery, University General Hospital of Castellón, Av Benicasim s/n, 12004, Castellón, Spain
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Tate S, Nishikimi K, Kato K, Matsuoka A, Kambe M, Kiyokawa T, Shozu M. Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer. J Gynecol Oncol 2019; 31:e34. [PMID: 31912684 PMCID: PMC7189082 DOI: 10.3802/jgo.2020.31.e34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/21/2019] [Accepted: 11/10/2019] [Indexed: 12/16/2022] Open
Abstract
Objective This study aimed to evaluate the presence of pathological residual tumor (pRT) in each initial disseminated site after neoadjuvant chemotherapy (NACT) to assess the appropriate surgical margins during interval debulking surgery (IDS) for a favorable prognosis. Methods This prospective descriptive study included patients with stage IIIC–IV epithelial ovarian, fallopian tubal, and peritoneal cancer. One hundred eleven patients underwent diagnostic exploratory laparotomy, and their initial intra-abdominal dissemination statuses were recorded. Any tumor >1 cm in diameter found during the exploratory laparotomy was resected during IDS even if it was macroscopically invisible after NACT. The pRT rate after NACT and negative predictive value (NPV; probability that sites with macroscopically invisible tumors have no pRT) during IDS were assessed in each disseminated site. Results A median of 5 NACT cycles were performed. Sites with a high incidence of pRT and low NPV included the rectosigmoid colon (71.4%, 38.6%), transverse mesentery (70.3%, 50.0%), greater omentum (68.3%, 51.7%), right diaphragm (61.9%, 48.1%), paracolic gutters (61.1%, 50.0%), and vesicouterine pouch (56.6%, 50.0%). Organs/tissues with a high incidence of pRT featured a low NPV. The median progression-free survival and overall survival in this cohort were 27.7 and 71.9 months, respectively. Conclusion Even if a disseminated site >1 cm in diameter before NACT is invisible during IDS, microscopic disease remains present within it. The appropriate surgical margins for IDS with a favorable prognosis could be secured by resecting a lesion of >1 cm before NACT even if it is invisible during IDS.
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Affiliation(s)
- Shinichi Tate
- Department of Gynecology, Chiba University Hospital, Chiba, Japan.
| | - Kyoko Nishikimi
- Department of Gynecology, Chiba University Hospital, Chiba, Japan
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Ayumu Matsuoka
- Department of Gynecology, Chiba University Hospital, Chiba, Japan
| | - Michiyo Kambe
- Department of Pathology, Nasional Hospital Organization Chiba Medical Center, Chiba, Japan
| | - Takako Kiyokawa
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Makio Shozu
- Department of Gynecology, Chiba University Hospital, Chiba, Japan
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Lim MC, Yoo HJ, Song YJ, Seo SS, Kang S, Kim SH, Yoo CW, Park SY. Survival outcomes after extensive cytoreductive surgery and selective neoadjuvant chemotherapy according to institutional criteria in bulky stage IIIC and IV epithelial ovarian cancer. J Gynecol Oncol 2018; 28:e48. [PMID: 28541636 PMCID: PMC5447147 DOI: 10.3802/jgo.2017.28.e48] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/25/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the survival outcomes in patients with bulky stage IIIC and IV ovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvant chemotherapy (NAC) according to institutional criteria. Methods Medical records for advanced ovarian cancer patients who were treated at National Cancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewed in the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases were included. Current NCC indication for NAC is determined based on patients' performance status and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially including chemotherapy-resistant cancer cells, were surgically removed. Results Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136 (49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achieved in 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. The median progression-free survival (PFS) and overall survival (OS) time were 20 months and not reached, but might be estimated more than 70 months in the PDS group and 15 and 70 months in the NAC group, respectively. Conclusion Extensive cytoreductive surgery to minimize residual tumor and selective use of NAC based on the institutional criteria could result in improved survival outcomes. Until further studies can be done to define the selection criteria for NAC after surgery, institutional criteria for NAC should consider the ability of the surgeon and institutional capacity.
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Affiliation(s)
- Myong Cheol Lim
- Cancer Healthcare Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Center for Clinical Trials, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Heong Jong Yoo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam, Korea
| | - Yong Jung Song
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Precision Medicine Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sun Ho Kim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chong Woo Yoo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Common Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
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Greggi S, Falcone F, Carputo R, Raspagliesi F, Scaffa C, Laurelli G, Giorda G, Di Vagno G, Petruzzelli F, Cormio G, Marinaccio M, Pignata S. Primary surgical cytoreduction in advanced ovarian cancer: An outcome analysis within the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) Group. Gynecol Oncol 2016; 140:425-9. [DOI: 10.1016/j.ygyno.2016.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Neo-adjuvant chemotherapy does not increase the rate of complete resection and does not significantly reduce the morbidity of Visceral–Peritoneal Debulking (VPD) in patients with stage IIIC–IV ovarian cancer. Gynecol Oncol 2015; 138:252-8. [DOI: 10.1016/j.ygyno.2015.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/14/2015] [Indexed: 12/28/2022]
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Chang SJ, Bristow RE, Chi DS, Cliby WA. Role of aggressive surgical cytoreduction in advanced ovarian cancer. J Gynecol Oncol 2015. [PMID: 26197773 DOI: 10.3802/jgo.2015.26.4.336] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ovarian cancer is the eighth most frequent cancer in women and is the most lethal gynecologic malignancy worldwide. The majority of ovarian cancer patients are newly diagnosed presenting with advanced-stage disease. Primary cytoreductive surgery and adjuvant taxane- and platinum-based combination chemotherapy are the standard treatment for advanced ovarian cancer. A number of studies have consistently shown that successful cytoreductive surgery and the resultant minimal residual disease are significantly associated with survival in patients with this disease. Much has been written and even more debated regarding the competing perspectives of biology of ovarian cancer versus the value of aggressive surgical resection. This review will focus on the current evidences and outcomes supporting the positive impact of aggressive surgical effort on survival in the primary management of ovarian cancer.
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Affiliation(s)
- Suk Joon Chang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - William A Cliby
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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11
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Affiliation(s)
- Sokbom Kang
- National Cancer Center, Goyang, 411-769, South Korea.
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12
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Chang SJ, Bristow RE, Chi DS, Cliby WA. Role of aggressive surgical cytoreduction in advanced ovarian cancer. J Gynecol Oncol 2015. [PMID: 26197773 PMCID: PMC4620371 DOI: 10.3802/jgo.2015.26.4.336] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ovarian cancer is the eighth most frequent cancer in women and is the most lethal gynecologic malignancy worldwide. The majority of ovarian cancer patients are newly diagnosed presenting with advanced-stage disease. Primary cytoreductive surgery and adjuvant taxane- and platinum-based combination chemotherapy are the standard treatment for advanced ovarian cancer. A number of studies have consistently shown that successful cytoreductive surgery and the resultant minimal residual disease are significantly associated with survival in patients with this disease. Much has been written and even more debated regarding the competing perspectives of biology of ovarian cancer versus the value of aggressive surgical resection. This review will focus on the current evidences and outcomes supporting the positive impact of aggressive surgical effort on survival in the primary management of ovarian cancer.
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Affiliation(s)
- Suk Joon Chang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - William A Cliby
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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Fagö-Olsen CL, Ottesen B, Kehlet H, Antonsen SL, Christensen IJ, Markauskas A, Mosgaard BJ, Ottosen C, Soegaard CH, Soegaard-Andersen E, Hoegdall C. Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study. Gynecol Oncol 2013; 132:292-8. [PMID: 24321400 DOI: 10.1016/j.ygyno.2013.11.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS). METHODS All patients treated in Danish referral centers with stage IIIC or IV epithelial ovarian cancer from January 2005 to October 2011 were included. Data were obtained from the Danish Gynecological Cancer Database, the Danish National Patient Register and medical records. RESULTS Of the 1677 eligible patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT-IDS had shorter operation times, less blood loss, less extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT-IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had better MOS when treated with PDS compared with NACT-IDS (55.5 and 36.7 months, respectively, p = 0.002). In a multivariate analysis, NACT-IDS was associated with increased risk of death after two years of follow-up (HR: 1.81; CI: 1.39-2.35). CONCLUSIONS No difference in MOS was observed between PDS and NACT-IDS. However, patients without residual tumor had superior MOS when treated with PDS, and NACT-IDS could be associated with increased risk of death after two years of follow-up.
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Affiliation(s)
| | - Bent Ottesen
- Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Sofie L Antonsen
- Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Ib J Christensen
- The Finsen Laboratory and Biotech Research and Innovation Center (BRIC), Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Algirdas Markauskas
- Department of Gynecology and Obstetrics, Odense University Hospital, Denmark
| | - Berit J Mosgaard
- Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Gynecology and Obstetrics, Herlev Hospital, Copenhagen University Hospital, Denmark
| | - Christian Ottosen
- Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Claus Hoegdall
- Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark
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14
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Querleu D, Ray-Coquard I, Classe JM, Aucouturier JS, Bonnet F, Bonnier P, Darai E, Devouassoux M, Gladieff L, Glehen O, Haie-Meder C, Joly F, Lécuru F, Lefranc JP, Lhommé C, Morice P, Salengro A, Stoeckle E, Taieb S, Zeng ZX, Leblanc E. Quality indicators in ovarian cancer surgery: report from the French Society of Gynecologic Oncology (Societe Francaise d'Oncologie Gynecologique, SFOG). Ann Oncol 2013; 24:2732-9. [PMID: 23857961 DOI: 10.1093/annonc/mdt237] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Based on registries, the European experience has been that <50% of patients are treated according to protocols and/or benefit from the minimum required surgery for ovarian cancer. The French Cancer Plan 2009-2013 considers the definition of qualitative indicators in ovarian cancer surgery in France. This endeavour was undertaken by the French Society of Gynaecologic Oncology (SFOG) in partnership with the French National College of Obstetricians and Gynecologists and all concerned learned societies in a multidisciplinary mindset. METHODS The quality indicators for the initial management of patients with ovarian cancer were based on the standards of practice determined from scientific evidence or expert consensus. RESULTS The indicators were divided into structural indicators, including material (equipment), human (number and qualification of staff), and organizational resources, process indicators, and outcome indicators. CONCLUSIONS The enforcement of a quality assurance programme in any country would undoubtedly promote improvement in the quality of care for ovarian cancer patients and would result in a dramatic positive impact on their survival. Such a policy is not only beneficial to the patient, but is also profitable for the healthcare system.
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Affiliation(s)
- D Querleu
- Department of Surgery, Institut Claudius Regaud, Toulouse, France
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15
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Optimal Debulking Targets in Women With Advanced Stage Ovarian Cancer: A Retrospective Study of Immediate Versus Interval Debulking Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:558-566. [DOI: 10.1016/s1701-2163(16)35272-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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