Cytoreduction For Epithelial Ovarian Cancer Research Articles

Risk Prediction Model for Surgical Complications and Predictors of Delay/Omission of Adjuvant Chemotherapy Post Primary Cytoreduction in Epithelial Ovarian Cancer

Risk Prediction Model for Surgical Complications and Predictors of Delay/Omission of Adjuvant Chemotherapy Post Primary Cytoreduction in Epithelial Ovarian Cancer

Splenectomy in epithelial ovarian cancer surgery

ObjectiveSplenectomy is performed in 4–32% of cytoreductive surgeries for ovarian cancer. The objective of our study was to assess splenectomy and evaluate its impact on overall and disease-free survival.MethodsWe conducted...

Maximal Effort Cytoreduction in Epithelial Ovarian Cancer: Perioperative Complications and Survival Outcomes from a Retrospective Cohort.

Background: Rates of maximal effort cytoreductive surgery in ovarian cancer patients increase gradually the last decade. The purpose of the present study is to evaluate factors that contribute to survival and morbidity outcomes in this group of patients. Methods: We retrospectively reviewed patient records of epithelial ovarian cancer patients with an intermediate and high Mayo Clinic surgical complexity score, operated between January 2010 and December 2018. Results: Overall, 107 patients were enrolled in the present study with a median age of 62 years (23-84) and a follow-up of 32 months (2-156). Thirteen Clavien-Dindo grade IIIa complications were documented in 10 patients (9.3%). Of all the investigated factors, only stage IVb (p = 0.027) and interval debulking surgery (p = 0.042) affected overall survival rates. Overall survival outcomes of patients operated on a primary setting started to differentiate compared to those that received neo-adjuvant chemotherapy after the 4th postoperative year. Conclusions: Maximal effort cytoreductive procedures should be considered feasible in the modern surgical era, as they are accompanied by acceptable rates of perioperative morbidity. Hence, every effort should be made to perform them in the primary setting, rather than following neoadjuvant chemotherapy as current evidence favor increased survival rates of patients that will likely surpass an interval of observation of more than 4 years.

Factors Predicting Surgical Effort Using Explainable Artificial Intelligence in Advanced Stage Epithelial Ovarian Cancer.

Simple SummaryIn the era of personalized medicine, Artificial Intelligence (AI) has emerged as a powerful tool with growing applications in the field of gynaecologic oncology. However, AI applications are encountered with several challenges derived from their “black-box” nature, which limits their adoption by clinicians. Surgical decision-making at cytoreductive surgery for epithelial ovarian cancer (EOC) is a complex matter, and an accurate prediction of surgical effort is required to ensure the good health and care of patients. We combined high-performance AI modeling with an eXplainable Artificial Intelligence (XAI) framework to explain feature effects and interactions associated with specific threshold surgical effort using data from a single public institution. We revealed features not routinely measured in the clinical practice, including human factors that could be responsible for the variation in the surgical effort. Selective decreased surgical effort may be associated with the surgeon’s age. The use of XAI frameworks can provide actionable information for surgeons to improve patient outcomes in gynaecologic oncology.(1) Background: Surgical cytoreduction for epithelial ovarian cancer (EOC) is a complex procedure. Encompassed within the performance skills to achieve surgical precision, intra-operative surgical decision-making remains a core feature. The use of eXplainable Artificial Intelligence (XAI) could potentially interpret the influence of human factors on the surgical effort for the cytoreductive outcome in question; (2) Methods: The retrospective cohort study evaluated 560 consecutive EOC patients who underwent cytoreductive surgery between January 2014 and December 2019 in a single public institution. The eXtreme Gradient Boosting (XGBoost) and Deep Neural Network (DNN) algorithms were employed to develop the predictive model, including patient- and operation-specific features, and novel features reflecting human factors in surgical heuristics. The precision, recall, F1 score, and area under curve (AUC) were compared between both training algorithms. The SHapley Additive exPlanations (SHAP) framework was used to provide global and local explainability for the predictive model; (3) Results: A surgical complexity score (SCS) cut-off value of five was calculated using a Receiver Operator Characteristic (ROC) curve, above which the probability of incomplete cytoreduction was more likely (area under the curve [AUC] = 0.644; 95% confidence interval [CI] = 0.598–0.69; sensitivity and specificity 34.1%, 86.5%, respectively; p = 0.000). The XGBoost outperformed the DNN assessment for the prediction of the above threshold surgical effort outcome (AUC = 0.77; 95% [CI] 0.69–0.85; p < 0.05 vs. AUC 0.739; 95% [CI] 0.655–0.823; p < 0.95). We identified “turning points” that demonstrated a clear preference towards above the given cut-off level of surgical effort; in consultant surgeons with <12 years of experience, age <53 years old, who, when attempting primary cytoreductive surgery, recorded the presence of ascites, an Intraoperative Mapping of Ovarian Cancer score >4, and a Peritoneal Carcinomatosis Index >7, in a surgical environment with the optimization of infrastructural support. (4) Conclusions: Using XAI, we explain how intra-operative decisions may consider human factors during EOC cytoreduction alongside factual knowledge, to maximize the magnitude of the selected trade-off in effort. XAI techniques are critical for a better understanding of Artificial Intelligence frameworks, and to enhance their incorporation in medical applications.

Cost-effectiveness of hyperthermic intraperitoneal chemotherapy at primary cytoreduction of epithelial ovarian cancer based on residual disease status

Hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin when used at the time of interval cytoreductive surgery (ICS) after neoadjuvant chemotherapy (NACT) has been shown to provide a survival advantage compared to interval cytoreduction alone for patients with advanced epithelial ovarian cancer in a cost-effective manner. A recent large multi-center retrospective cohort study showed a survival advantage with HIPEC given during primary debulking surgery compared to surgery alone. While there is an ongoing randomized controlled trial examining HIPEC at the time of primary cytoreductive surgery (PCS) before chemotherapy (OVHIPEC-2), there is currently no study of this practice in the United States or cost data to inform incorporation of this practice. To help guide the use of HIPEC in the upfront setting until the results of the OVHIPEC-2 are available in 2026, a decision-analytic cost-effectiveness model of the US healthcare sector was developed for patients undergoing PCS with or without HIPEC. Effectiveness inputs were extracted from a Chinese retrospective cohort study of 425 patients who underwent PCS with HIPEC and 159 patients who underwent PCS alone. We found incremental cost effectiveness ratios (ICER) of $9,789 per life year saved (LYS) for optimal PCS, $18,164/LYS for suboptimal PCS, and $7,854/LYS for all patients. Our findings provide preliminary data to support that HIPEC at the time of primary cytoreductive surgery can be considered cost-effective regardless of residual disease status when using a standard willingness to pay threshold.

Cost-effectiveness of hyperthermic intraperitoneal chemotherapy at primary cytoreduction of epithelial ovarian cancer based on residual disease status

<h3>Objectives:</h3> Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to confer an overall survival (OS) benefit in a cost-effective manner when used at interval cytoreductive surgery after neoadjuvant chemotherapy for advanced ovarian cancer. Regarding the use of HIPEC at primary cytoreductive surgery (PCS), a recent multicenter retrospective cohort study demonstrated an OS advantage compared to PCS alone in women with stage III epithelial ovarian cancer (EOC). The objective of this study was to evaluate the cost-effectiveness of HIPEC in this setting. <h3>Methods:</h3> A decision analytic cost-effectiveness model of the US health care sector using simulated patients with stage III primary epithelial ovarian cancer was developed for three scenarios: 1) patients with optimal cytoreduction, 2) patients with suboptimal cytoreduction, and 3) all patients regardless of residual disease status. The base case for each model compared two surgical strategies: 1) PCS versus 2) PCS with HIPEC. Model inputs including median survival time, Kaplan-Meier estimates of OS, and costs were obtained from published studies. The time horizon was three years. The primary outcome was incremental cost-effectiveness ratio (ICER) in US dollars per life-year saved (LYS). <h3>Results:</h3> Assuming a willingness-to-pay threshold of $100,000 per LYS, PCS with HIPEC could be considered cost-effective in all three scenarios compared with PCS alone. The ICER was $9,789/LYS in optimally cytoreduced patients, $18,164/LYS in suboptimally cytoreduced patients, and $7,854/LYS for all patients regardless of residual disease burden. <h3>Conclusions:</h3> PCS with HIPEC appears to be a cost-effective strategy for patients with advanced epithelial cancer with all ICERs far below the willingness-to-pay threshold. This warrants further investigation of HIPEC in these clinical settings.

A novel laparoscopy-based model for the prediction of optimal cytoreduction and prognosis of epithelial ovarian cancer in a Chinese population

ObjectivesThis study aimed to investigate the predictive value of laparoscopy for the prediction of optimal cytoreduction and prognosis of epithelial ovarian cancer (EOC) in a Chinese population. Study designThis study enrolled 162 EOC patients in Obstetrics and Gynecology Hospital of Fudan University from January 2015 to December 2016. All patients underwent preoperative CT scans and laparoscopic assessments. Each patient was scored according to the CT-based predictive model by Bristow and laparoscopy-based predictive model by Fagotti. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of each model were calculated. The predictive scores and clinicopathologic factors were all analyzed using the Kaplan-Meier method and multivariate Cox analysis. A prognostic predictive nomogram was formulated in R software. ResultsThe AUCs of the laparoscopy-based predictive model and CT-based predictive model was 0.955 and 0.755 respectively. At a laparoscopic score ≥ 10, the possibility of optimal cytoreduction was 0, and the risk of unnecessary explorative attempts was 6%. Additionally, laparoscopic score, independent of residual tumor size and FIGO stage, was an independent prognostic factor for both overall survival (OS) and recurrence-free survival (RFS) in EOC. Notably, the predictive nomogram that we established further confirmed the prognostic value of laparoscopy for prognostic predictions in EOC. ConclusionsLaparoscopy has a better discriminating performance than CT in the prediction of optimal cytoreduction in EOC. Moreover, the laparoscopic score is directly correlated with the survival of EOC patients. The laparoscopic score-based nomogram we established showed good potential to predict the prognosis of EOC patients.

The Ability Pre-operative Serum (Cancer Antigen-125, Fatty Acid Synthase, and Glucose Transporter) to Predict Primary Suboptimal Cytoreduction in Epithelial Ovarian Cancer

BACKGROUND: The incidence of ovarian cancer ranks 8th in the world, with 295,414 cases and 184,799 death in 2018. Management in ovarian cancer is surgery and chemotherapy. Some studies state that patients who underwent optimal cytoreduction surgery have better survival rates than suboptimal cytoreduction surgery. The pre-operative serum assessed in this study was Cancer Antigen-125 (CA-125), Fatty Acid Synthase (FASN), and Glucose Transporter (GLUT) to predict suboptimal cytoreduction in epithelial ovarian cancer (EOC).&#x0D; AIM: We aimed to use FASN and GLUT1 as other biomarkers, besides CA-125, to predict suboptimal cytoreduction surgery in epithelial ovarian cancer. &#x0D; METHODS: This observational-analytic cross-sectional study included 109 women diagnosed with epithelial ovarian cancer (EOC) between 2017 and 2019, who had serum CA-125, FASN, and GLUT measured preoperatively and underwent cytoreductive surgery.&#x0D; RESULTS: The results of the statistical analysis test in this study obtained p values at CA-125 (p = 0.0001), FASN (p = 0.017), and at GLUT (p = 0.013). While the cutoff point (COP) on CA-125 was 248.55, FASN was 0.445, and GLUT was 0.1980. The value of area under curve (AUC) obtained by the ROC method at CA-125 76.7%, FASN 65.3%, and GLUT 63.8%. The combination of CA-125 and FASN shows AUC value 76.9%, the combination of CA-125 and GLUT shows AUC value 72.2%, and the combination of the three shows AUC value 75.2%.&#x0D; CONCLUSION: The use of CA-125 as a predictor of cytoreduction surgery is still considered to be the best predictor compared to serum biomarkers in this study.

Risk Factors for Severe Complications in Ovarian Cancer Surgery.

A total of 345 EOC patients who underwent cytoreductive surgery were retrospectively evaluated regarding risk factors for an unfavorable postoperative course. Possible pre-, intra- and postoperative risk factors were statistically analyzed performing multivariate ordinal logistic regression. A total of 345 EOC patients underwent cytoreductive surgery. There were no complications in 114 patients, mild complications in 114 patients and severe complications in 117 patients. The risk factor evaluation identified age (p=0.049), smoking (p=0.032) and duration of surgery (p<0.0001) as significant factors for severe postoperative morbidity. In EOC patients age, smoking and the duration of surgery have significant impact on the postoperative course. Only the duration of surgery can be positively influenced by a well-trained EOC team.

The parameters to estimate postoperative severe complications classified through Clavien-Dindo after upper abdominal surgery in patients with primary and recurrent ovarian cancer.

The more surgical effort and performing extensive upper abdominal surgery (UAS) are often required to accomplish the highest rates of optimally cytoreduction in patients with ovarian cancer. Nonetheless, the rate of complications increases with extensive surgery. We have studied the upper abdominal surgery complications by Clavien-Dindo Classification (CDC) and analyzed parameters affecting post-operative severe complications classified through Clavien-Dindo. A retrospective cohort of patients diagnosed with epithelial ovarian cancer from January 1st 2009 to April 30th 2016 was evaluated. Patients who underwent at least one UAS procedure with or without optimal cytoreduction for epithelial ovarian cancer (stage IIIC-IV or recurrent) were included. Postoperative complications were recorded according to the Clavien-Dindo Classification. In total, 58 patients were included. There were 120 UAS procedures performed on the 58 patients. Diaphragm peritonectomy was the most performed surgery (50%, 29/58), and then the other UAS procedures were liver surgery (39.7%, 23/58), cholecystectomy (24.1%, 14/58), splenic surgery (24.1%, 14/58), full-thickness diaphragm resection (22.4%, 13/58), pancreatic surgery (19%, 11/58), resection of tumor from porta hepatis (17.2%, 10/58), celiac lymph node excision (8.6%, 5/58), partial gastrectomy (1.7%, 1/58), respectively. Thirteen patients (22.4%) had post-operative grade 3-5 complications according to CDC within 30 days after surgery. This current study demonstrated that the addition of extensive upper abdominal surgery procedures were not associated with increased postoperative severe complications in patients with recurrent or advanced ovarian cancer. These procedures are safe and feasible for patients in need and also can be performed with acceptable mortality and morbidity.

Pre-operative prediction of residual disease after interval cytoreduction for epithelial ovarian cancer using HE4

BackgroundPresence of residual disease after cytoreductive surgery is an important negative prognostic factor for patients with advanced stage epithelial ovarian cancer. Surgery is of limited benefit when the diameter of...

Clinical Significance of Nodal Positivity Following Neoadjuvant Chemotherapy in Epithelial Ovarian Cancer

Purpose Metastasis in retroperitoneal lymph nodes is found to be relatively chemoresistant according to various studies. The role of systematic lymphadenectomy in advanced epithelial ovarian cancer is a controversial topic. The aim of this study is to determine the rate of lymph node positivity in patients undergoing interval cytoreduction in epithelial ovarian cancer and its effect on recurrence-free and overall survival.

Time to chemotherapy following surgical cytoreduction for epithelial ovarian cancer: Does neoadjuvant chemotherapy make a difference?

Time to chemotherapy following surgical cytoreduction for epithelial ovarian cancer: Does neoadjuvant chemotherapy make a difference?

Utilizing propensity scores to determine the risk of recurrence and death in epithelial ovarian cancer.

5577 Background: Perioperative red blood cell transfusion (PRBCT) may be a negative prognostic marker in surgical oncology. We assessed PRBCT as an independent risk factor for recurrence and death from epithelial ovarian cancer (EOC) in the largest cohort to date. Methods: Patient characteristics and process-of-care variables (NSQIP-defined, &gt;130 variables) were retrospectively abstracted from 587 women who underwent primary staging and cytoreduction for EOC (1/1/03-12/29/08). Evaluated using propensity scoring with univariate logistic regression and odds ratios (OR) and Cox proportional hazards regression and hazard ratios (HR). Factors with p&lt;0.1 used in multivariate models. Results: Rate of PRBCT was 77.0% (452/587). In univariable analysis, PRBCT was associated with older age (OR 1.25[95% CI 1.06, 1.48]/10yr increase), stage≥IIIa (4.66[3.04, 7.13]), splenectomy (26.63[3.67, 193.17]), higher surgical complexity (1.86[1.17, 2.95] score 2; 21.48 [7.37, 62.59] 3; referent 1), serous histology (2.36[1.57, 3.55]vs non-serous), longer operating time (1.58[1.36, 1.83]/hr increase), and residual disease (3.26[1.97, 5.41]≤1cm; 1.97[1.09, 3.56]&gt;1cm), and lower preop hemoglobin (Hb) (1.89[1.59, 2.27]per 1g/dL decrease). In univariable analysis, PRBCT was associated with a higher risk of recurrence (HR 1.96[95% CI 1.43, 2.68]) and death (1.71[1.28, 2.28]). However, in multivariable analysis, stage≥IIIa (4.03[2.05, 6.49]), splenectomy (1.41[1.02, 1.95]), residual disease (1.86[1.41, 2.46]≤1cm; 2.91[2.02, 4.18]&gt;1cm), and lower preop Hb (1.09[1.01, 1.19]) were associated with higher risk of recurrence. Older age (1.24[1.12, 1.37]), stage≥IIIa (3.07[1.93, 4.90]), albumin ≤3 g/dL (2.06[1.28, 3.31]), residual disease (1.63[1.22, 2.19]≤1cm; 3.03[2.19, 4.18]&gt;1cm), and low Hb (1.08[1.00, 1.19]) were associated with higher risk of death. Serous histology (0.70[0.52, 0.95]) associated with lower risk of death. Conclusions: PRBCT does not appear to be directly associated with disease-free and overall survival in EOC. Lower preoperative Hb was associated with a higher risk of both recurrence and death. The need for PRBCT appears to be a stronger prognostic indicator than the receipt of PRBCT.

Primary versus secondary cytoreduction for epithelial ovarian cancer: A paired analysis of tumour pattern and surgical outcome

ObjectiveRecurrence rates of Epithelial Ovarian Cancer (EOC) remain high. Aim of the present study was to compare tumour pattern and surgical outcome at primary and secondary tumourdebulking in a paired patients’ collective. MethodsSeventy-nine consecutive EOC-patients who underwent both primary and secondary cytoreduction in our institution between 09/2000 and 12/2010 were evaluated according to a validated documentation-tool (‘IMO’, Intraoperative Mapping Ovarian Cancer). Differences in tumour-pattern between paired samples were examined using McNemar-test or sign-test. ResultsA complete macroscopic tumour resection could be achieved significantly more often during primary versus secondary surgery (77% versus 50%; p<0.001) in comparable operative times (242min versus 199min; p=0.15) and by equivalent operative morbidity (25% versus 29%; p=0.424). Tumour-residuals at primary correlated significantly with tumour-residuals at secondary cytoreduction (p=0.003). Patients at relapse had significantly higher rates of tumour involvement of the gastric serosa (2.5% versus 16.9%; p=0.001), serosa of small intestine (20.3% versus 44.9%; p<0.001) and mesentery (30.4% versus 50%; p=0.012). The relative-risk for peritoneal carcinosis, intestinal tumour involvement or positive lymph nodes at secondary tumourdebulking in the case of presence of these features at primary surgery was 1.53 (95% CI: 0.89–2.63); 0.92 (95% CI: 0.65–1.31) and 1.49 (95% CI: 0.83–2.68), respectively, and thus not reaching a statistical significance. ConclusionsSecondary cytoreduction due to EOC appears to be associated with significantly lower optimal tumourdebulking rates compared to primary setting, since the disease tends to recur in patterns less accessible to complete resection such as gastrointestinal serosa, mesentery and upper abdomen. By maximal surgical effort, tumour residuals significantly correlate between primary and secondary cytoreduction. No other predictors of surgical outcome or tumour-pattern could be identified.

Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection

Studies addressing mesenteric and mesocolic lymph node metastasis in patients with advanced ovarian cancer that have undergone bowel resection are lacking. A retrospective analysis was performed in a series of 50 individuals who underwent surgical cytoreduction for epithelial ovarian cancer that included bowel resection from April 2004 to September 2010. Forty-one patients had bowel resection with mesenteric lymph nodes that were suitable for analysis. Twenty-four (58.5%) patients underwent retosigmoidectomies, 14 (34.1%) received other types of colectomies, and three (7.3%) underwent small bowel resection. There was serosal involvement in 14 cases (34.1%), muscularis propria invasion in 13 cases (31.7%), submucosa invasion in six cases (14.6%), and mucosa in eight cases (19.5%). Lymphatic invasion was observed in 24 patients (58.5%). A median of 14 mesenteric lymph nodes were analyzed. Metastatic lymph nodes were observed in 29 (70.7%) cases. Invasion into the muscularis propria (P = 0.036), lymphatic invasion (P = 0.045), and retroperitoneal lymph node metastasis (P = 0.002) correlated significantly with mesenteric lymph node involvement. Resection of regional lymph nodes of affected organs that is similar to surgical procedures that are performed for colorectal carcinoma is an appropriate, optimal debulking surgery for patients with ovarian carcinoma.

Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review

Surgical cytoreduction and platinum/taxane combination chemotherapy are the mainstay for the treatment of epithelial ovarian cancer patients. In order to minimise the tumour mass before chemotherapy, cytoreductive surgery is usually performed first. Currently, a splenectomy is included as part of surgical cytoreduction in epithelial ovarian cancer, but it is rarely performed. A splenectomy is also performed as part of secondary cytoreduction surgery. Although there are many reports on surgical techniques, safety and associated clinical outcomes of a splenectomy as a standard adjunct of ovarian cytoreductive surgery, most evidence is from case(s) reports, with only a few studies. Thus, we conducted a review of the literature on this unusual procedure in the context of primary and secondary cytoreduction of epithelial ovarian cancer to assess the published evidence for its efficacy and safety.

The Role of Bowel Surgery with Cytoreduction for Epithelial Ovarian Cancer

Aims To assess the efficiency and morbidity associated with bowel resection with the initial cytoreduction procedure for advanced ovarian cancer. Materials and methods A review was carried of 95 patients with ovarian cancer who underwent cytoreductive surgery between 2000 and 2003. The relationship between dichotomised preoperative, intra-operative and postoperative outcome variables were tested using SPSS software. Kaplan–Meier curves were generated to compare survival. Cox proportional hazards regression was used to determine the independent significance of factors after cytoreductive surgery. Results In patients in whom bowel resection was carried out, the largest residual tumour mass was <1 cm in 66.67% of patients, compared with 45.28% of patients undergoing surgery without bowel resection ( P = 0.038). The median survival in the optimally debulked patients was 50.38 months compared with 37.15 months in the patients who had suboptimal cytoreduction ( P = 0.0021). The median survival in patients undergoing bowel resection was 50.70 months compared with 44.62 months in the patients who had cytoreduction without bowel resection ( P = 0.2176). Multivariate analysis showed that optimal cytoreduction ( P = 0.005) was found to be independently prognostic for overall survival. Major adverse events, such as ileus, intestinal fistulae, urinary tract fistulae, were not significantly different between groups. Conclusion Bowel resection is a worthwhile endeavour in selected patients with advanced ovarian cancer to increase therapeutic efficiency. The surgical morbidity rate from these procedures is not serious and seems acceptable.

RETRACTED: A study to evaluate the utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer

To determine the ability of a preoperative serum CA125 to predict optimal primary tumor cytoreduction in patients with stage III and IV epithelial ovarian cancer (EOC). The records of patients with advanced stage who underwent primary surgery for EOC at Tehran University, Vali-Asr Hospital between 2000 and 2002 were reviewed. Inclusion criteria included FIGO stage III/IV disease, surgery by gynecologic oncology faculty, preoperative CA125, and an operative note clearly defining volume of residual disease. Without optimal cytoreduction was determined using the receiver operator curve (ROC). One hundred and twenty cases of advanced stage EOC were identified, of which 90 cases of stage III/IV met our inclusion criteria. Serum CA125 < or = 400 was identified with OD > or = 75% of the time. Conversely, optimal cytoreduction was performed in < or = 40% of patients with CA125 > or =4000. The area under the ROC curve for CA125 was 0.680. The optimal cytoreduction rate for those with and without ascites was 38% and 77%, respectively (P<0.001). In a multivariate analysis using CA125, age, and ascites, the area under the curve was 0.696. We conclude that CA125 level did not reliably predict optimal cytoreduction in patients with stage III-IV EOC.

Hepatic resection for metachronous metastases from ovarian carcinoma

Recently, several authors have reported that optimal primary cytoreduction of both hepatic and extrahepatic disease is not only feasible but improves survival. However, the role of hepatic resection in combination with secondary cytoreduction for epithelial ovarian cancer is unclear. Patients with recurrent ovarian cancer and metachronous intrahepatic metastases are often evaluated by a multidisciplinary team at the Mayo Clinic comprising pelvic and hepatobiliary surgeons for consideration of cytoreductive surgery. The purpose of this report is to update the outcome of cytoreductive surgery including hepatic resection for patients with metastatic ovarian carcinoma.