Current status of tertiary debulking surgery and prognosis after secondary debulking surgery for recurrent M\xfcllerian epithelial cancer in Japan: a retrospective analysis of 164 patients (KCOG-G1402)

Tomoko Hirakawa,Atsushi Arakawa,Kana Iwai,Shoko Sakurada,Hiroyuki Morisawa,Hiroshi Taniguchi ,Keiichi Kawano ,Yoshio Itani,Kenta Yoshida,Taisuke Mori,Kimihiko Ito,Hiroaki Nagano,Saki Murase,Tomohiko Tsuruta,Hiroki Sato,Takeo Minaguchi,Motoaki Saito,Yoshihiro Kasamatsu ,Masanori Kaneuchi,Takashi Ushiwaka,Fumitaka Saito,Kazuhiro Takehara,Kaei Nasu

doi:10.1186/s12957-017-1200-x

Abstract

BackgroundThis study aimed to evaluate the current status of secondary debulking surgery (SDS) and tertiary debulking surgery (TDS; performed for recurrence after SDS) and to assess the overall survival after recurrence of Müllerian epithelial cancer in Japan. We also evaluated the data of patients who underwent a fourth debulking surgery (i.e., quaternary debulking surgery (QDS)).MethodsWe conducted a retrospective study of 164 patients with recurrent Müllerian epithelial cancers (i.e., ovarian, tubal, and peritoneal cancers). The SDS was performed between January 2000 and September 2014 in 20 Japanese hospitals. Clinicopathological data were collected and analyzed.ResultsOf the 164 patients, 66 patients did not have a recurrence or died after SDS. Ninety-eight patients had a recurrence after SDS. Forty-three of the 98 patients underwent TDS; 55 of the 98 patients did not undergo TDS and were classified into the non-TDS group. The overall survival (OS) after SDS was significantly better in the TDS group than in the non-TDS group. The median OS after SDS was 123 and 42 months in the TDS group and non-TDS group, respectively. Of the 43 patients who received TDS, 11 patients were further treated with QDS. The median OS after SDS was 123 months for patients who underwent QDS.ConclusionsThis multicenter study on the prognosis of post-SDS is apparently the first report on QDS in Japan. Patients undergoing TDS have a good prognosis, compared to patients in the non-TDS group. Novel drugs are being evaluated; however, debulking surgery remains a necessary treatment for recurrence.

Highlights

This study aimed to evaluate the current status of secondary debulking surgery (SDS) and tertiary debulking surgery (TDS; performed for recurrence after SDS) and to assess the overall survival after recurrence of Müllerian epithelial cancer in Japan
The patient selection criteria were as follows: a complete response was achieved by the primary treatment, patients were histologically diagnosed with Müllerian epithelial cancers, and SDS was performed between January 2000 and September 2014
Forty-three of the 98 patients were classified into the TDS group

Summary

Introduction

This study aimed to evaluate the current status of secondary debulking surgery (SDS) and tertiary debulking surgery (TDS; performed for recurrence after SDS) and to assess the overall survival after recurrence of Müllerian epithelial cancer in Japan. Secondary debulking surgery (SDS; known as secondary cytoreductive surgery) is an effective option if the patients are selected carefully [1,2,3,4]. Secondary debulking surgery seems to be effective if complete resection has been achieved. The AGO DESKTOP OVAR Trial (DESKTOP I trial) showed that only complete surgery was associated with prolonged survival in patients with recurrent ovarian cancer [6]. The trial presented a predictive score for the resectability of recurrent ovarian cancer. This score model was based on the performance status, the presence of ascites, and the outcome of the primary surgery [6, 7]. The DESKTOP II trial was subsequently the first prospective multicenter trial that successfully validated a clinical score that could be used to predict complete resection [8]

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