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.
Highlights
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
Aggressive surgery is not performed during interval debulking surgery (IDS) in patients with a high initial peritoneal cancer index (PCI) score before initiation of neoadjuvant chemotherapy (NACT)18 because many initially disseminated tumors become invisible after NACT, and only visible tumors can be resected during IDS
We hypothesized that aggressive surgery with resection of the initial > 1 cm dissemination would overcome the high PCI score by selecting primary debulking surgery (PDS) or NACT followed by IDS depending on whether cytoreduction to no residual disease is achievable at initial laparotomy before starting treatment
Summary
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. Among the several assessment tools for the extent of peritoneal dissemination[1,2,3,4,5,6], peritoneal cancer index (PCI) is precise and reproducible for the assessment of the location and size of lesions in 13 abdominopelvic r egions[1,2] It has been universally used for the assessment of the prognosis or surgical resectability of gastrointestinal carcinomas. The treatment option for patients who could not achieve complete resection with PDS is neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). It is unclear whether aggressive surgery overcomes the extent of dissemination for the patients treated with IDS. Variables Age, median [IQR] Primary site Ovary Fallopian tube Peritoneal Performance status 0 1 2 3 FIGO stage IIIC IV Histology High-grade serous Non high-grade serous
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