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Nikiforchin A, Sardi A, King MC, Baron E, Lopez-Ramirez F, Falla-Zuniga LF, Barakat P, Iugai S, Pawlikowski K, Nieroda C, Campbell K, Ryu H, Diaz-Montes T, Gushchin V. Collaborative expertise of gynecological and surgical oncologists in managing advanced epithelial ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107948. [PMID: 38183864 DOI: 10.1016/j.ejso.2023.107948] [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: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Most patients with epithelial ovarian cancer (EOC) present with significant peritoneal spread. We assessed collaborative efforts of surgical and gynecological oncologists with expertise in cytoreductive surgery (CRS) in the management of advanced EOC. METHODS Using a prospective single-center database (2014-2022), we described the operative and oncologic outcomes of stage IIIC-IVA primary and recurrent EOC perioperatively managed jointly by gynecological and surgical oncologists both specializing in CRS and presented components of this collaboration. RESULTS Of 199 identified patients, 132 (66 %) had primary and 53 (27 %) had recurrent EOC. Due to inoperable disease, 14 (7 %) cases were aborted and excluded from analysis. Median peritoneal cancer index (PCI) in primary and recurrent patients was 21 (IQR: 11-28) and 21 (IQR: 6-31). Upper abdominal surgery was required in 95 % (n = 125) of primary and 89 % (n = 47) of recurrent patients. Bowel resections were performed in 83 % (n = 110) and 72 % (n = 38), respectively. Complete cytoreduction (CC-0/1) with no disease or residual lesions <2.5 mm was achieved in 95 % (n = 125) of primary and 91 % (n = 48) of recurrent patients. Ninety-day Clavien-Dindo grade III-IV morbidity was 12 % (n = 16) and 21 % (n = 11), respectively. Median follow-up was 44 (95%CI: 33-55) months. Median overall survival in primary and recurrent EOC was 68 (95%CI: 45-91) and 50 (95%CI: 16-84) months. Median progression-free survival was 26 (95%CI: 22-30) and 14 (95%CI: 7-21) months, respectively. CONCLUSIONS Perioperative collaboration between surgical and gynecological oncologists specializing in CRS allows safe performance of complete cytoreduction in the majority of patients with primary and recurrent EOC, despite high tumor burden.
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Affiliation(s)
- Andrei Nikiforchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Armando Sardi
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA.
| | - Mary Caitlin King
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Ekaterina Baron
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Felipe Lopez-Ramirez
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Luis Felipe Falla-Zuniga
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Philipp Barakat
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Sergei Iugai
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Kathleen Pawlikowski
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Carol Nieroda
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Kurtis Campbell
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Hyung Ryu
- Gynecological Oncology, The Lya Segall Ovarian Cancer Institute, Mercy Medical Center, 227 St. Paul Place, 6th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Teresa Diaz-Montes
- Gynecological Oncology, The Lya Segall Ovarian Cancer Institute, Mercy Medical Center, 227 St. Paul Place, 6th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
| | - Vadim Gushchin
- Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg Building, Baltimore, MD, 21202-2001, USA
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