A multicenter prospective assessment of surgical findings associated with suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube and peritoneal cancer

Abstract

multiagent chemotherapy regimens preoperatively. Patient and disease characteristics, including age, FIGO stage and score, antecedent pregnancy, number of pulmonary metastases, other sites of disease, human chorionic gonadotropin (hCG) levels before and after surgery, and number and type of preoperative and postoperative chemotherapy regimens, were evaluated with respect to outcome. Results: Fifteen (26%) of 58 patients treated for high-risk GTN underwent pulmonary resection with curative intent. Mean age of patients was 29 years (range, 19–37 years). FIGO stage was III in 12 patients and IV in 3. FIGO scores ranged from 5 to 20 (mean, 10). Antecedent pregnancy was nonmolar in 11 patients (73%). Adjuvant surgical procedures other than pulmonary resection were performed in eight patients (53%). The number of preoperative chemotherapy regimens ranged from 1 to 12 (median, 4) and courses numbered from 2 to 32 (median, 14). Preoperative hCG levels ranged from 2 to 2786 mIU/mL (median, 177 mIU/mL). Pulmonary wedge resections or lobectomies were performed via video-assisted thoracoscopic surgery (11) or thoracotomy (4). Two patients underwent pulmonary resections on two separate occasions. No patient had complications as a result of these procedures. Eleven patients (73%) were cured. In these 11 patients, hCG levels decreased to b2 mIU/mL within 6 to 52 days (mean, 22 days) postoperatively. Of the four patients who were not cured, mean FIGO score was 13, three had preoperative hCG levels N1700 mIU/mL, two had brain metastases, and one was noncompliant with follow-up chemotherapy. Conclusions: Pulmonary resection of chemotherapy-resistant GTN was an important component of treatment in 26% of high-risk patients, resulting in a 73% cure rate. Ideal candidates have disease isolated to the lungs and low hCG levels. However, even some patients with multiple lesions in one lung requiring more than one primary resection or recurrent pulmonary disease requiring repeat surgery may still be curable. Postoperative chemotherapy should be administered.