Surgery For Ovarian Cancer Research Articles

The Role of Cytoreductive Surgery in Platinum-Resistant Ovarian Cancer (PROC): A Systematic Review.

Platinum-resistant ovarian cancer (PROC) has limited therapeutic options, and the role of cytoreductive surgery (CRS) in improving survival outcomes remains uncertain. We performed a systematic review to evaluate the oncological benefit of CRS on PROC patients and the associated surgical morbidity and mortality. We followed a prospective protocol according to PRISMA guidelines. We searched PubMed, Medline, and Embase till October 2024. We used a "Population Intervention Comparator Outcomes (PICO)" framework. Our population included women with epithelial PROC who underwent CRS with/without chemotherapy. Our outcomes included overall survival (OS), progression-free-survival (PFS), post-operative morbidity and mortality and Quality of Life. Our search yielded 6590 citations; six studies (N = 155 patients) were included. There is limited evidence available on the role of CRS in PROC, with notable variation in reported outcomes and outcomes' measures; therefore, we were unable to perform quantitative synthesis. CRS demonstrated survival benefits in well-selected PROC patients, particularly those with limited, isolated recurrences, low tumour burden, and good performance status. Complete resection (R0) was associated with significantly longer OS/PFS compared to those who had suboptimal surgeries (R1/R2). CRS seems to extend survival in carefully selected PROC patients, especially those with limited disease spread and favourable surgical profiles. Nevertheless, CRS carries substantial surgical risks, and its benefits appear contingent upon achieving R0. Further prospective trials with standardised patient selection criteria are needed to define CRS's role in PROC. At present, CRS in PROC should be considered within a multidisciplinary approach in specialised gynaecological oncology centres, with the careful assessment of patient-specific risk factors and potential for R0 resection.

Return to intended oncological therapy following advanced ovarian cancer surgery: a narrative review.

Patients with advanced ovarian cancer often require radical cytoreductive surgery and chemotherapy, with or without targeted therapy. Return to intended oncological therapy after surgery is a crucial metric, as delay can worsen survival. The concept of return to intended oncological therapy is important because it highlights the need for not just successful surgical outcomes, but also the ability to continue with the comprehensive cancer treatment plan. A comprehensive review of the literature was conducted to identify relevant English language studies published from January 2010 to September 2024. Delayed return to intended oncological therapy after surgery was associated with poor survival outcomes in ovarian cancer. This narrative review investigates how pre-operative counselling and education; optimisation of the patient's medical condition; meticulous surgical planning and execution; early recognition of complications; and comprehensive postoperative care influence return to intended therapy in gynaecological surgery. Effective multidisciplinary care involving anaesthetists; nurses; physiotherapists; dietitians; psychologists; and the patient's relatives or friends, can prevent complications and ensure timely return to intended oncological therapy. Awareness and management of factors affecting return to intended oncological therapy are essential for improving outcomes in patients with advanced ovarian cancer. We highlight the importance of multidisciplinary care (including enhanced recovery after surgery programmes) and the factors affecting these including age; nutrition; and occurrence of postoperative complications.

Pregnancy after advanced ovarian cancer with spontaneous uterine rupture in second trimester: A case report and review of the literature.

Fertility-preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31-year-old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low-grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra-cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long-term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus.

Oncological safety of minimally invasive surgery in borderline ovarian tumor and ovarian cancer: a retrospective comparative study.

This study aimed to evaluate the oncological safety of laparoscopic surgery for patients with benign tumors who underwent laparoscopic surgery at our facility and were subsequently diagnosed with borderline ovarian tumors or ovarian cancer. We conducted a retrospective review of 45 patients initially diagnosed with benign ovarian tumors who underwent laparoscopic surgery at our institution from January 2009 to April 2024. Postoperative pathological examination identified 32 cases of borderline ovarian tumors and 13 cases of ovarian cancer. Laparoscopic cystectomy was performed in 14 (43.8%) borderline cases and 4 (30.8%) ovarian cancer cases. Out of 14 patients with borderline ovarian tumors who underwent cystectomy, 8 subsequently underwent staging laparotomy, whereas 6 underwent only ovarian tumor cystectomy. In contrast, none of the patients with ovarian cancer completed treatment with only ovarian tumor cystectomy. Recurrent disease was observed in 9.4% of borderline tumor cases, all of which were successfully managed with further surgery. In the ovarian cancer group, recurrence occurred in 31% of patients, with 3 resulting in tumor-related mortality. Laparoscopic surgery for borderline ovarian tumors is suggested to be oncologically safe, with low recurrence rate and no adverse impact on survival. However, for ovarian cancer, particularly in cases with peritoneal dissemination, rapid disease progression remains a concern. While this study suggests that laparoscopic surgery may be a viable option for borderline ovarian tumors, further research is needed to validate these findings, particularly for ovarian cancer.

Persistent and severe hypotension during radical transabdominal ovarian cancer surgery: A case report.

In radical surgery for ovarian cancer (OC), hypotension that is difficult to correct is usually rare unless there is significant blood loss. We recently encountered a patient who developed persistent and severe hypotension during radical transabdominal OC surgery. A patient was 52 years old with a history of hypertension and well-controlled preoperative blood pressure (BP). A total of 2000 mL of ascites was drained and blood loss was 300 mL when the operation proceeded to 5.5 hours. The patient's cardiopulmonary function and blood gas analysis showed no significant abnormalities. persistent and uncorrectable hypotension. There was no significant edema in the patient's head or face, nor did the surgeon observe noticeable edema in her intestinal walls or other organs. No oozing was seen at the surgical site. Fluid resuscitation and vasopressor administration were continued. As BP control further deteriorated, blood counts, coagulation, and biochemical electrolyte analyses revealed severe hypoalbuminemia (13.5 g/L) and coagulation dysfunction. After intravenous human serum albumin (HSA) and fresh frozen plasma therapy, her hypoalbuminemia and coagulation were gradually corrected. Based on this case, we suggest that in OC patients experiencing mild intraoperative bleeding and minimal heart rate variation but persistent refractory hypotension, hypoalbuminemia should be considered even if preoperative biochemical tests (including serum albumin levels) are normal. Confirming hypoalbuminemia warrants HSA administration to alleviate hypovolemic shock symptoms. Additionally, it is important to be cautious of potential coagulation issues with albumin use, possibly requiring plasma infusion to address coagulopathy.

Prediction of surgical outcomes in ovarian cancer based on CT imaging

This study aims to investigate the commonly used prediction models for the outcomes of ovarian cancer surgery. The study will select 71 cases from the TCGA-OV dataset and divide them into a training set (n=51) and a validation set (n=20) at a ratio of 7:3. The project is based on PyRadiomics Python3.0.1 and extracts 107 basic image features from the image group data, including first-order statistics, shape, gray-level co-occurrence matrix, gray-level size zone matrix, GLRLM, etc. On this basis, the LASSO algorithm is used for feature dimensionality reduction. In building the model, a fuzzy matrix is used to analyze multiple evaluation indicators, including the area under the receiver operating characteristic (ROC) curve (AUC). This study hopes to provide more precise diagnostic and treatment plans for patients, with the goal of achieving better treatment outcomes.

Hyperthermic intraperitoneal chemotherapy for recurrent ovarian cancer (CHIPOR): a randomised, open-label, phase 3 trial

Hyperthermic intraperitoneal chemotherapy (HIPEC) at interval cytoreductive surgery for ovarian cancer improves overall survival but its role in recurrent disease is uncertain. We aimed to compare outcomes in patients treated with or without HIPEC during surgery for recurrent ovarian cancer. The multicentre, open-label, randomised, phase 3 CHIPOR trial was conducted at 31 sites in France, Belgium, Spain, and Canada, and enrolled patients with first relapse of epithelial ovarian cancer at least 6 months after completing platinum-based chemotherapy. Eligible patients were aged 18 years or older with WHO performance status of less than 2. After six cycles of platinum-based chemotherapy (and optional bevacizumab), patients amenable to complete cytoreductive surgery were randomly assigned centrally in a 1:1 ratio, using a web-based system and a minimisation procedure, during surgery to receive HIPEC (cisplatin 75 mg/m2 in 2 L/m2 of serum at 41±1°C for 60 min) or not, stratified by centre, completeness of cytoreduction score, platinum-free interval, and latterly, planned poly(ADP-ribose) polymerase inhibitor use. The primary endpoint was overall survival, analysed on an intention-to-treat basis in all randomly assigned patients. This ongoing trial is registered with ClinicalTrials.gov, NCT01376752. Between May 11, 2011, and May 14, 2021, 415 female patients were randomly assigned (207 HIPEC, 208 no HIPEC). At the primary analysis (median follow-up 6·2 years, IQR 4·1-8·1), 268 (65%) patients had died (126 [61%] of 207 in the HIPEC group; 142 [68%] of 208 in the no-HIPEC group). Overall survival was significantly improved with HIPEC (stratified hazard ratio 0·73, 95% CI 0·56-0·96; p=0·024). Median overall survival was 54·3 months (95% CI 41·9-61·7) with HIPEC versus 45·8 months (38·9-54·2) without. Grade 3 or worse adverse events within 60 days after surgery occurred in 102 (49%) of 207 patients receiving HIPEC versus 56 (27%) of 208 receiving no HIPEC, the most common being anaemia (47 [23%] vs 30 [14%]), hepatotoxicity (23 [11%] vs 18 [9%]), electrolyte disturbance (28 [14%] vs two [1%]), and renal failure (20 [10%] vs three [1%]). There were three deaths within 60 days of surgery, all in the no-HIPEC group. Adding HIPEC to cytoreductive surgery after response to platinum-based chemotherapy at first epithelial ovarian cancer recurrence significantly improved overall survival. When treating patients with late first relapse of high-grade serous or high-grade endometrioid ovarian cancer amenable to complete cytoreductive surgery at specialist centres, platinum-based HIPEC should be considered to extend overall survival. French National Cancer Institute and French League Against Cancer.

Preoperative Platelet to Lymphocyte Ratio Can Help Predict Residual Disease After Primary Debulking Surgery for Epithelial Ovarian Cancer

Preoperative Platelet to Lymphocyte Ratio Can Help Predict Residual Disease After Primary Debulking Surgery for Epithelial Ovarian Cancer

Factors associated with intraoperative blood transfusion in patients undergoing debulking surgery for ovarian cancer

Factors associated with intraoperative blood transfusion in patients undergoing debulking surgery for ovarian cancer

Clinical effects of debulking surgery combined with neoadjuvant chemotherapy in treating ovarian cancer and its influence on tumor markers and immune function.

Exploring the clinical efficacy of tumor cell reduction combined with neoadjuvant chemotherapy in treatment of ovarian cancer. Retrospective analysis was conducted of one hundred patients with advanced ovarian cancer at Yellow River Sanmenxia Hospital from January 2017 to December 2022. They were divided into control group and observation group based on treatment methods, with 50 cases in each group. The control group was treated with tumor cell reduction surgery, the observation group treated with neoadjuvant chemotherapy and tumor cell reduction surgery. The surgical related conditions, clinical treatment effects, tumor markers, cellular immune function levels, quality of life, and adverse reactions were compared. The observation group had shorter surgical and hospitalization times, with less intraoperative blood loss and abdominal fluid accumulation compared to control group (P<0.05). The serum levels in both groups of patients were significantly reduced, and observation group had a higher degree of decrease (P<0.05). The levels of cellular immune function levels in both groups improved significantly, and observation group showed more significant improvement (P<0.05). The total efficacy of observation group patients was 72.00%, higher than control group's 52.00% (P<0.05). The SS-QOL scores of both groups of patients improved significantly, and the degree of improvement in observation group was significant (P<0.05). The combination of tumor cell reduction surgery and neoadjuvant chemotherapy for ovarian cancer can significantly shorten surgical and hospitalization time, inhibit tumor marker expression, improve patient immune function and quality of life.

Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study

ObjectiveThe efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation. MethodsA retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. ResultsAmong the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of P = 0.05. ConclusionCT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.

Healthy days at home after surgery for ovarian cancer: A patient-centered outcome in older adults

Healthy days at home after surgery for ovarian cancer: A patient-centered outcome in older adults

Hypoalbuminemia alone is not a contraindication to primary cytoreductive surgery in advanced ovarian cancer

Hypoalbuminemia alone is not a contraindication to primary cytoreductive surgery in advanced ovarian cancer

The value of transitory protective stomas during primary debulking surgery for advanced epithelial ovarian cancer: a retrospective cohort study.

Limited data are available on patients with advanced-stage epithelial ovarian cancer (OC) who require ostomy during primary cytoreductive surgery. This study aimed to investigate the application of postoperative and long-term oncological results from transitory protective stoma (TPS) formation during primary debulking surgery for OC. This is a retrospective cohort study with a single center. The authors identified patients with stage III-IV OC who underwent colon resection and anastomosis. Depending on the methods used after colorectal anastomosis and the outcomes of surgical resection, the patients were stratified into three groups: resection and end-to-end anastomosis, resection and ostomy, or R1 resection. Demographic and clinical data were analyzed. Eighty-four patients underwent colorectal resection during cytoreduction for FIGO stage III-IV OC. Patients undergoing ostomy were more likely to have a longer mean operative time (266 vs. 283 vs. 236min; P =0.003) and to undergo rectosigmoid resection at the time of cytoreductive surgery (56.0 vs. 22.7%, P =0.007). Their postoperative feeding (7 vs. 1 vs. 3 days, P <0.001) and exhaustion (6 vs. 3 vs. 3, P <0.001) times were similar to those of patients with R1 resection and much earlier than those of patients with intestinal anastomosis. The first normal time (35 days) and half-life (14.68 days) of CA125 after surgery were significantly better in patients with TPS group. The overall incidence of complications was the same, and there was no significant difference in the 30-day readmission rate. The overall quality of life assessment was significantly lower in the R1 resection group. TPSs can accelerate postoperative recovery and the initiation of postoperative chemotherapy, reduce the risk of mortality and disease progression and limit the incidence of complications.

Evaluating the risks of pleural effusions and chest tube placement at the time of cytoreductive surgery for advanced ovarian cancer

Evaluating the risks of pleural effusions and chest tube placement at the time of cytoreductive surgery for advanced ovarian cancer

Further analysis of phase III, single-dose, open-label study to investigate the efficacy of pafolacianine sodium injection (OTL38) for intraoperative imaging during cytoreductive surgery of folate receptor-positive ovarian cancer (NCT03180307)

Further analysis of phase III, single-dose, open-label study to investigate the efficacy of pafolacianine sodium injection (OTL38) for intraoperative imaging during cytoreductive surgery of folate receptor-positive ovarian cancer (NCT03180307)

Effect of the local anaesthetic ropivacaine intraperitoneally during and after cytoreductive surgery on time-interval to adjuvant chemotherapy in advanced ovarian cancer: a randomised, double-blind phase III trial

BackgroundIn a previous phase II trial, intraperitoneal local anaesthetics shortened the time interval between surgery and adjuvant chemotherapy, an endpoint associated with improved survival in advanced ovarian cancer. Our objective was to test this in a phase III trial. MethodsA double-blind, phase III parallel superiority trial was conducted at two university hospitals in Sweden, within a public and centralised healthcare system. Women >18 yr with advanced ovarian cancer scheduled for cytoreductive surgery, an ASA physical status of 1–3 with no speech/language issues, were eligible. Participants were randomly assigned using a central computerised system to receive either ropivacaine 0.2% or saline 0.9% (placebo) intraperitoneally during and after surgery. The primary endpoint was time to return to intended oncologic therapy (RIOT), analysed using t-test and linear regression adjusted for centre. ResultsOf the 225 women randomised between August 2020 and December 2023 (ropivacaine n=113; placebo n=112), 175 were included in the modified intention-to-treat analysis (ropivacaine n=86; placebo n=89). Median age: ropivacaine group 64 yr (56–73 yr), placebo group: 66 yr (57–74 yr). The mean RIOT in the ropivacaine group was 26.5 days vs 25.8 days in the placebo group, with a mean difference of 0.7 days (−2.2 to 3.4 days; P=0.65). Per-protocol analysis of 166 women yielded similar results, mean difference of 0.5 days (−2.4 to 3.4 days; P=0.74) days. There were no differences in short-term recovery or postoperative morbidity. ConclusionIntraperitoneal local anaesthetic did not shorten the time to RIOT among women undergoing surgery for advanced ovarian cancer in this trial. Clinical trial registrationClinicalTrials.gov (NCT04065009), European Union Clinical Trials Register (2019-003299-38/SE).

Assessment of the five factor modified frailty index in predicting postoperative complications and non-home discharge in patients undergoing interval cytoreductive surgery for ovarian cancer

Assessment of the five factor modified frailty index in predicting postoperative complications and non-home discharge in patients undergoing interval cytoreductive surgery for ovarian cancer

Postoperative complications in elderly patients undergoing surgery for ovarian cancer: A NSQIP analysis

Postoperative complications in elderly patients undergoing surgery for ovarian cancer: A NSQIP analysis

Implementation of enhanced recovery protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for metastatic ovarian cancer following neoadjuvant chemotherapy. A feasibility study

ObjectiveThe aim of this study is to evaluate the implementation of the elements of enhanced recovery (ERAS) protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for metastatic ovarian cancer. ERAS protocols have shown improvement in the perioperative outcomes of patients who underwent cytoreductive surgery for metastatic ovarian cancer by reducing the length of stay as well as the postoperative complications and by improving patients’ postoperative experience. MethodsThis is a feasibility study involving retrospective analysis from (31) patients who underwent cytoreductive surgery and HIPEC versus (35) a control group that underwent cytoreductive surgery only, prior to the introduction of the HIPEC programme for metastatic ovarian cancer. All patients had undergone neoadjuvant chemotherapy prior to surgery. We compared the compliance for each element of the ERAS protocol between the two study groups. ResultsWe analyzed data from 66 patients, 31 in HIPEC group and 35 in the control goup. We found no significant difference in the patients’ characteristics between the two groups and there were no differences in the implementation of 8 elements of the ERAS protocols (100 % for both groups). The use of nasogastric tube was more frequently observed in patients undergoing surgery and HIPEC compared to those undergoing surgery alone (42 % vs 0 %, respectively; p < 0.001). The number of patients who were mobilized on the first postoperative day was higher in the group undergoing surgery and HIPEC (87.1 % vs 57.1 %, respectively; p = 0.007), however there was no significant difference in the percentage of patients that had early removal of the urinary catheter (p = 0.12), nor in the percentage of patients that received early feeding (p = 0.18). Finally, there were no statistically significant differences in the complication rates, the length of hospital stay and the re-admission rates between the two groups. ConclusionEnhanced recovery protocols can be implemented safely in patients undergoing cytoreductive surgery and HIPEC for ovarian cancer.