Extensive Primary Cytoreductive Surgery Research Articles

The paradigm shift in advanced ovarian cancer: Outcomes of extensive primary cytoreductive surgery. A single-center retrospective analysis

ObjectiveThe standard surgical treatment of advanced ovarian carcinoma is primary debulking surgery (PDS) aiming to complete cytoreduction. The need to achieve complete cytoreduction has shifted the surgical paradigm to more complex procedures, whose impact on morbidity is controversial. The objective of this retrospective analysis is to explore the impact of extensive PDS on morbidity and oncologic outcomes in a real-world scenario. MethodsA retrospective single-center analysis was performed on 137 patients with advanced high-grade ovarian carcinoma (HGOC) who received PDS in 2015–2020. Patients treated in 2015–2017 (Group 1) were compared to patients treated in 2018–2020 (Group 2). The two periods were chosen according to the higher complexity of surgical procedures introduced in 2018. ResultsThe increase in complete cytoreduction observed in Group2 (RD 0: 33 % vs 61 %, p = 0,008) was related to a higher surgical complexity (Aletti Score: 4 vs 6, p = 0,003) and did not reflect an increase in peri-operative complications (CCI: 20,9 vs 20,9, p = 0,11). After a median FUP of 44 months, PFS and OS at 24 months were 33,60 % vs 47,33 % (p = 0,288) and 72,10 % vs 80,37 % (p = 0,022) in Group 1 and 2, respectively. ConclusionsAn extensive surgical effort leads to a significant increase in complete cytoreduction with acceptable morbidity. Arm-in-arm with novel maintenance therapies, it contributes to increasing the outcomes of patients with advanced HGOC.

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

BJOG: An International Journal of Obstetrics & GynaecologyVolume 115, Issue 13 p. 1713-1714 A statement for extensive primary cytoreductive surgery in advanced ovarian cancer R Naik, R Naik Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorRJ Edmondson, RJ Edmondson Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorK Galaal, K Galaal Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorMH Hatem, MH Hatem Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorKA Godfrey, KA Godfrey Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this author R Naik, R Naik Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorRJ Edmondson, RJ Edmondson Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorK Galaal, K Galaal Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorMH Hatem, MH Hatem Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this authorKA Godfrey, KA Godfrey Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UKSearch for more papers by this author First published: 13 November 2008 https://doi.org/10.1111/j.1471-0528.2008.01945.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume115, Issue13December 2008Pages 1713-1714 RelatedInformation

Author response to: A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

Author response to: A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

Author response to: A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

Author response to: A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

C Pomel,a DPJ Barton,b I McNeish,c J Shepherda a Department of Gynaecological Oncology, St Bartholomew’s Hospital, London, UK b Department of Surgery, Royal Marsden, London, UK c Department of Medical Oncology, St Bartholomew’s Hospital, London, UK Correspondence: Dr C Pomel, Department of Gynaecological Oncology, St Bartholomew’s Hospital, Gloucester House 7th Floor, Barts and The London NHS Trust, London EC1A 7BE, UK. Email christophe.pomel@bartsandthelondon.nhs.uk

A statement for extensive primary cytoreductive surgery in advanced ovarian cancer

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Die Bedeutung der radikalen zytoreduktiven Chirurgie für die Überlebenszeit von Patientinnen mit fortgeschrittenem Ovarialkarzinom

Fragestellung: Mit dieser Studie sollten Prognosefaktoren identifiziert werden, die das Überleben bei Frauen mit fortgeschrittenem epithelialen Ovarialkarzinom und maximaler zytoreduktiver Operation beeinflussen. Material und Methode: Zwischen 1996 und 2001 wurden 99 Patientinnen ausgewertet, welche an der Frauenklinik des Universitätsklinikums Hamburg Eppendorf primär zytoreduktiv bei fortgeschrittenem Ovarialkarzinom (FIGO III/IV) operiert wurden. In dieser Zeit wurde prospektiv angestrebt, eine maximale operative Zytoreduktion, d. h. postoperativ makroskopisch Tumorfreiheit, zu erreichen. Ergebnisse: Es fanden sich 76 Patientinnen im Stadium FIGO III sowie 23 im Stadium FIGO IV. 91 (92 %) Patientinnen erhielten im Anschluss an die Operation eine platinhaltige Chemotherapie und 71 (72 %) diese in Kombination mit Taxol. Die mediane Beobachtungszeit betrug 25 Monate. Bei 57 Patientinnen (58 %) konnte postoperativ makroskopisch Tumorfreiheit erreicht werden, bei 27 Patientinnen (27 %) musste ein Tumorrest < 1 cm belassen werden. Somit konnte bei 85 % der Patientinnen ein „optimales zytoreduktives Ergebnis“ erreicht werden. Für das Gesamtkollektiv der Patientinnen mit fortgeschrittenem Ovarialkarzinom (FIGO III + IV) fand sich eine mediane Überlebenszeit von 48 Monaten und eine kumulative 5-Jahres-Überlebens-Wahrscheinlichkeit von 42 %. Bei Tumorrest bis 9 mm 60 Monate bzw. 52 %. In der multivariaten Analyse aller Prognoseparameter (Cox-Regression) stellt die postoperative makroskopische Tumorfreiheit den einzigen statistisch signifikanten Parameter dar, der die Mortalität vermindert (HR: 0,610; KI: 0,428 - 0,87). Die Komplikationsrate lag bei 31 %, die postoperative Mortalität (90 Tage) bei 3 %. Schlussfolgerung: Bei den meisten Patientinnen mit fortgeschrittenem Ovarialkarzinom ist eine optimale Zytoreduktion ohne Steigerung der Komplikationsrate durchführbar und verbessert deutlich die Überlebenschance. Unsere Ergebnisse zeigen, dass die Prognose der Erkrankung nicht von der Ausbreitungsform oder der Tumorbiologie, sondern vor allem vom Volumen des postoperativ verbliebenen Tumorrestes abhängt. Auch bei Patientinnen mit Zeichen einer aggressiven Tumorbiologie sollte deshalb mit allen Mitteln eine radikale Operation, mit dem Ziel makroskopischer Tumorfreiheit, angestrebt werden.

Extensive Primary Cytoreductive Surgery for Advanced Epithelial Ovarian Cancer

This retrospective descriptive study provides our experience with a subset of 30 patients with Stage III or Stage IV ovarian cancer who presented at initial laparotomy with advanced disease in whom large (greater than 10 cm) confluent nodules, plaques, or nodal metastatic deposits were found intraperitoneally. The nature of the extirpative procedures performed resuited in extensive primary cytoreductive surgery involving multiple organ resection. All the patients had removal of their primary tumor from the pelvis, an omentectomy, and appendectomy. In addition to resection of rectosigmoid colon in 27 patients, 11 had concomitant resection of the small bowel and 13 of the large bowel, 3 of which were hemicolectomy. In the remaining 3 patients who did not have rectosigmoid resection a hemicolectomy was performed, 2 of which also had resection of small bowel. Three patients required a primary colostomy, while 1 had a colostomy as a secondary procedure following the development of a rectovaginal fistula. Eight patients had a splenectomy, 2 had resection of portion of the tail of the pancreas, 10 had a partial urinary bladder cystectomy and 2 had a nephrectomy. The average operating time and blood loss was 5 hr 18 min and 2900 ml, respectively. Two patients died within 48 hr postoperatively, two required a second laparotomy for persistent intraabdominal bleeding, and six developed late thrombotic complications. In total 43% of the patients developed serious postoperative complications. We present our findings and allude to the morbidity and mortality that may ensue when such extensive cytoreductive surgery is undertaken.