Total Colectomy as a Part of Ultra-Radical Surgery for Ovarian Cancer-Short- and Long-Term Outcomes.

Sebastian Szubert,Blazej Nowakowski,Lukasz Wicherek,Artur Skowyra,Pawel Pawlowicz,Marek Szczepkowski,Andrzej Wójtowicz

doi:10.3390/curroncol28050358

Abstract

(1) Background: The aim of this study was to assess the outcomes for patients who underwent total colectomy (TC) as a part of surgery for ovarian cancer (OC). (2) Methods: We performed a retrospective analysis of 1636 OC patients. Residual disease (RD) was reported using Sugarbaker’s completeness of cytoreduction score. (3) Results: Forty-two patients underwent TC during primary debulking surgery (PDS), and four and ten patients underwent TC during the interval debulking surgery (IDS) and secondary cytoreduction, respectively. The median overall survival (mOS) in OC patients following the PDS was 45.1 months in those with CC-0 (21%) resection, 11.1 months in those with CC-1 (45%) resection and 20.0 months in those with CC-2 (33%) resection (p = 0.28). Severe adverse events were reported in 18 patients (43%). In the IDS group, two patients survived more than 2 years after IDS and one patient died after 28.6 months. In the recurrent OC group, the mOS was 6.9 months. Patient age above 65 years was associated with a shortened overall survival (OS) and the presence of adverse events. (4) Conclusions: TC as a part of ultra-radical surgery for advanced OC results in high rates of optimal debulking. However, survival benefits were observed only in patients with no macroscopic disease.

Highlights

Ovarian cancer (OC) is the leading cause of death from gynecological malignancies in the Western world [1]
To evaluate the effect of total colectomy (TC) on patient survival in the group of patients treated during primary debulking surgery (PDS), we investigated the impact of the following confounders on patient survival: the presence of adverse events, diaphragmatic stripping, splenectomy, liver metastasectomy, residual disease (CC-0 and CC-1 vs CC-2 according to Sugarbaker’s completeness of cytoreduction score [15]), age, body mass index (BMI; below and above 25) and preoperative albumin level
We investigated the association between the adverse event occurrence and the following variables: diaphragmatic stripping, splenectomy, liver metastasectomy, lymphadenectomy, residual disease (CC-2 according to Sugarbaker’s completeness of cytoreduction score [15]), age, body mass index (BMI; below and above 25), preoperative albumin level and previous chemotherapy

Summary

Introduction

Ovarian cancer (OC) is the leading cause of death from gynecological malignancies in the Western world [1]. Cytoreductive surgery followed by platinum-based chemotherapy is recommended for the treatment of patients with OC [2,3]. Current research indicates a strong relationship between the amount of residual disease following the initial surgery and patient prognosis. In a meta-analysis by du Bois et al, the authors showed a threefold higher median overall survival (mOS) in patients whose surgery resulted in no gross macroscopic disease when compared to patients with minimal macroscopic residual disease (tumors in diameter < 1 cm) and to patients with nonoptimal debulking (tumors > 1 cm in diameter) [4]. The same research group showed that improvement in surgical skills, and thereafter the widening of the range of surgery, almost doubled the survival rates for OC patients [5]. Colon involvement is observed in more than one-third of OC patients [9,10]

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