Abstract
BackgroundThe aim of this study was to evaluate the survival benefit of radical surgery with additional extensive upper abdominal procedures (EUAS) for the treatment of stage IIIC and IV ovarian cancer with bulky upper abdominal disease (UAD).MethodsAn observational study was conducted between 2009 and 2012 involving two different surgical teams. Team A was composed of the “believers” in EUAS and Team B the “non-believers” in EUAS. Patients were divided into a radical surgery group (EUAS group) or a standard surgery group (non-EUAS group) according to whether or not they had received EUAS. All patients underwent primary cytoreductive surgery with the goal of optimal debulking (≤1 cm); this was reviewed in the pelvis, middle abdomen, and upper abdomen. The baseline for the two groups was optimal cytoreduction in both the pelvis and middle abdomen. Progression-free survival (PFS) was evaluated.ResultsRadical surgery was performed in 70.7 % (82/116) and 12.7 % (30/237) of the patients by Teams A and B, respectively. The study groups had similar clinicopathologic characteristics. The median PFS and OS were significantly improved in the radical surgery group, compared with standard surgery groups (PFS: 19.5 vs. 13.3 months, HR: 0.61; 95 % CI: 0.46–0.80, P < 0.001; OS: not reached vs. 39.3 months, HR: 0.47; 95 % CI: 0.30–0.72, P < 0.001). Positive predictors of complete cytoreduction were treatment with neoadjuvant chemotherapy, improved American Society of Anesthesiologists performance status, and the absence of bowel mesenteric carcinomatosis.ConclusionsRadical surgery lengthens the PFS and overall survival times of ovarian cancer patients with bulky UAD. However, a well-designed randomized trial is needed to confirm the present results.
Highlights
The aim of this study was to evaluate the survival benefit of radical surgery with additional extensive upper abdominal procedures (EUAS) for the treatment of stage IIIC and IV ovarian cancer with bulky upper abdominal disease (UAD)
Medical records were abstracted for the following data: age at primary cytoreduction; International Federation of Gynecology and Obstetrics (FIGO) stage; histology; tumor grade; Eastern Cooperative Oncology Group (ECOG) performance status; American Society of Anesthesiologists (ASA) score; preoperative serum cancer antigen (CA125); ascites and extent of disease at primary surgery; cytoreductive procedures; residual disease after primary cytoreduction; surgeons involved; type of frontline chemotherapy; estimated blood loss; intraoperative blood transfusion; operative time; intensive care unit (ICU) stay; length of hospitalization; postoperative 30day morbidity and mortality; progression-free survival (PFS), follow-up time; and survival time
In the radical surgery group, eight (7.1 %) patients were upstaged for pleural metastasis and 21 (18.8 %) were diagnosed with stage IV ovarian cancer in the EUAS group as compared with 26 (10.8 %) patients in the non-EUAS group
Summary
The aim of this study was to evaluate the survival benefit of radical surgery with additional extensive upper abdominal procedures (EUAS) for the treatment of stage IIIC and IV ovarian cancer with bulky upper abdominal disease (UAD). The goal of primary cytoreduction for advanced EOC is advocated to be no visible residual disease,which has been confirmed in several studies, but only less than 30 % of women with bulky upper abdominal disease (UAD) can achieve complete cytoreduction [2, 3]. Most of the surgeons tend to accept neoadjuvant chemotherapy followed by surgery as the standard approach, which is in line with the result of EORTC 55971 study reported in 2010 [8].
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