Aggressive surgery for advanced ovarian cancer performed by a multidisciplinary team: A retrospective analysis on a large series of patients

Stefano Rausei,Stefano Uccella,Valentina D'Alessandro,Baldo Gisone,Francesco Frattini,Georgios Lianos,Francesca Rovera,Luigi Boni,Gianlorenzo Dionigi,Fabio Ghezzi

doi:10.1016/j.sopen.2019.05.005

Abstract

BackgroundTo evaluate the impact of extended surgical treatment performed by a team of gynecologists and general surgeons on postoperative morbidity and survival of patients with advanced ovarian cancer. MethodsWe collected data of 156 patients with advanced ovarian cancer stage IIb-III-IV according to International Federation of Gynecology and Obstetrics classification and treated with primary cytoreduction. End points were perioperative and postoperative complications and cancer-related survival. ResultsIn 51 cases (51/156, 32.7%) a multivisceral resection was completed. Postoperative complications occurred in 52 cases (33.3%). The duration of the surgical procedure as well as the need for diaphragmatic peritonectomy were the factors independently associated with the development of postoperative complications. Five-year cancer-related survival rate was of 50.7%: only histotype and residual tumor resulted significantly associated. ConclusionsOur results highlight the importance of a team of gynecologists and general surgeons with specific interests and skills to achieve cytoreduction as rapidly as possible, even when it implies very complex maneuvers.

Highlights

Patients with advanced ovarian cancer (AOC) benefit from aggressive surgical management: robust evidences support the association between microscopic residual disease after surgery and longterm survival [1,2,3,4,5,6,7,8,9]
Postoperative complications occurred in 52 cases (33.3%): according to the Clavien-Dindo classification a grade I-II was observed in 25.0% of cases (39/156), a grade III in 7.1% (11/156), a grade IV in 0.6% (1/156), to the rate reported for grade V (0.6%, 1/156) (Table 2)
Over 70% of the patients receive a diagnosis of ovarian cancer only in cases of tumor spread beyond the ovaries (FIGO stages II, III, and IV), with frequent massive involvement of the peritoneal surfaces and intra-abdominal organs

Summary

Introduction

Patients with advanced ovarian cancer (AOC) benefit from aggressive surgical management: robust evidences support the association between microscopic residual disease after surgery and longterm survival [1,2,3,4,5,6,7,8,9]. Introduced: the neoadjuvant and adjuvant therapies [12,13] as well as a multispecialist surgery (beyond the conventional gynecologic oncologists) [14] This monocentric retrospective study reviews the impact of extended surgical treatment performed by a team of gynecologists and general surgeons with specific interests and skills in cytoreduction on postoperative morbidity and survival of patients with AOC. To evaluate the impact of extended surgical treatment performed by a team of gynecologists and general surgeons on postoperative morbidity and survival of patients with advanced ovarian cancer. Conclusions: Our results highlight the importance of a team of gynecologists and general surgeons with specific interests and skills to achieve cytoreduction as rapidly as possible, even when it implies very complex maneuvers

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