Surgery For Advanced Epithelial Ovarian Cancer Research Articles

Feasibility study on the use of single-port laparoscopic surgery for diagnosis and tumor sampling in advanced epithelial ovarian cancer — Case series of three cases

IntroductionIn advanced epithelial ovarian cancer (AEOC), it is often difficult to achieve optimal surgery at primary debulking surgery (PDS) due to intra-abdominal dissemination and/or metastasis. When it is determined that optimal surgery is not possible, neoadjuvant chemotherapy (NAC) is performed prior to subsequent debulking surgery. Also, a histological diagnosis of the tumor is very important before initiation of NAC. Laparoscopic surgery is thus useful to objectively diagnose whether an optimal primary debulking surgery is feasible and to obtain tumor biopsy samples. In order to minimize the invasive procedures at initial surgery, we performed laparoscopic surgery using a single-port method. Case presentationThree patients were diagnosed as stage IV ovarian cancer based on imaging and physical examination. Single-port laparoscopic surgery was performed. The intraabdominal findings were evaluated in all patients by predictive index scoring and objectively diagnosed as not ideal candidates for optimal surgery at PDS. Our use of single-port laparoscopic surgery (SPLS) allowed for safe surgical outcomes and sufficient tissue sampling for histological diagnosis. Clinical discussionLaparoscopic surgery is not appropriate for tumor reduction surgery in AEOC; however, its use as an alternative method to laparotomy is recommended for tumor tissue biopsy and/or intraperitoneal observation. Previous studies have reported on the use of conventional multi-port laparoscopic surgery. The single-port method, when compared to conventional laparoscopic surgery, is less invasive with only one abdominal wound at the umbilicus. ConclusionSPLS is feasible and clinically useful for diagnosis and tumor sampling in AEOC.

Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience

BackgroundCytoreductive surgery is currently the main treatment for advanced epithelial ovarian cancer (OC), and several surgical maneuvers, including colorectal resection, are often needed to achieve no residual disease. High surgical complexity carries an inherent risk of postoperative complications, including anastomosis leakage (AL). Albeit rare, AL is a life-threatening condition. The aim of this single-center retrospective study is to assess the AL rate in patients undergoing colorectal resection and anastomosis during primary surgery for advanced epithelial OC through a standardized surgical technique and to evaluate possible pre/intra- and postoperative risk factors to identify the population at greatest risk.MethodsA retrospective analysis of clinical and surgical characteristics of 515 patients undergoing colorectal resection and anastomosis during primary or interval debulking surgery between December 2011 and October 2019 was performed. Several pre/intra- and postoperative variables were evaluated by multivariate analysis as potential risk factors for AL.ResultsThe overall anastomotic leakage rate was 2.9% (15/515) with a significant negative impact on postoperative course. Body mass index < 18 kg/m2, preoperative albumin value lower than 30 mg/dL, section of the inferior mesenteric artery at its origin, and medium–low colorectal anastomosis (< 10 cm from the anal verge) were identified as independent risk factors for AL on multivariate analysis.ConclusionsAL is confirmed to be an extremely rare but severe postoperative complication of OC surgery, being responsible for increased early postoperative mortality. Preoperative nutritional status and surgical characteristics, such as blood supply and anastomosis level, appear to be the most significant risk factors.

Prognostic value of monocyte to lymphocyte ratio (MLR) in epithelial ovarian cancer (EOC).

e17066 Background: Identifying high-risk early-stage EOC patients (p) is a major issue. Also, controversy about the role of neoadjuvant chemotherapy prior to surgery in advanced EOC is still ongoing. A high MLR is related to poorer outcomes in several cancers, and also in ovarian cancer according to limited retrospective series. We explored the clinical value of MLR in a cohort of EOC p. Methods: We included all EOC p diagnosed in our center, from January 2008 to April 2017, who had undergone radical treatment. Overall survival (OS) was assessed by Kaplan Meyer. Maximally selected rank statistics was used to determine the MLR cut-off value for the greatest OS discrimination. The hazard ratio (HR) of death of MLR was explored by multivariate Cox regression models, adjusted by age at diagnosis, stage I/II versus (vs) III/IV, high grade serous carcinomas (HGSC) vs other, primary surgery vs interval surgery after neoadjuvant chemotherapy (PS, IS), residual disease &lt; 1 vs &gt; 1cm, year of diagnosis, and hemoglobin, neutrophils, platelets and MLR at diagnosis. Results: 124 p were included. Median age at diagnosis was 58.7 years; 55.6% were HGSC;67.7% stage III/IV; 69.3% received PS; 14.3% had residual disease &gt; 1cm. Median OS was 75 months. MLR was the laboratory parameter that more significantly impacted on OS in our model (p = 0.02). Optimal MLR cut-off was 0.38. The MLR &gt; 0.38 group (MLR-hi) had a higher-risk of death (HR = 2.9; 95% IC: 1.3–6.5) with respect to those with MLR &lt; = 0.38 (MLR-lo). Median OS were 100 and 35 months, respectively. In the MLR-lo group, median age at diagnosis was 56.9 years (vs 61.9 in the MLR-hi, p 0.047), 44.8% were HGSC (vs 61.2%, p 0.134), and 49.97% were stages I/II (vs 14.2%, p 0.001). MLR-hi p who had undergone PS or IS had similar OS (p = 0.63). In contrast, among MLR-lo p, PS showed significantly higher OS than IS (p &lt; 0.0001). Conclusions: In our cohort, MLR was an independent prognostic factor in EOC. Its potential role to identify high-risk early-stage p and to predict worse outcomes after PS among advanced-stage p need to be explored in larger cohorts.

Ki67 expression as a predictor for suboptimally debulked patients with advanced epithelial ovarian cancer

5563 Objective: The death rate from ovarian cancer has not changed significantly in several decades. Additional prognostic biomarkers may allow for more tailored chemotherapy and an improved response rate. Our aim was to clarify the utility of Ki67, a nuclear protein expressed by mitotic cells, as a prognostic marker in cases of advanced epithelial ovarian cancer (EOC). Methods: We conducted a retrospective cohort study of patients undergoing primary surgery for advanced EOC between 1989 and 2003 at one institution. All were diagnosed with serous or poorly differentiated ovarian adenocarcinoma, and received platinum/paclitaxel chemotherapy. Snap-frozen surgical specimens were subjected to immunohistochemical analysis using a monoclonal antibody against human Ki67. Cases were stratified into those wtih high (&gt;25%) or low expression (&lt;25%) of Ki67 based on the percentage of postively-staining tumor cells. Kaplan-Meier curves were used to estimate five-year survival rates, and were compared using a log-rank statistic. Results: 134 cases (106 stage III; 28 stage IV) were analyzed. Average age at diagnosis was 62 (range 26–84 years); average duration of follow-up was 42 months (range 0.7 - 128.8). 61 (45%) patients were optimally debulked. The 5-year survival rates were 24.7% and 41.4% (p=0.0421) for patients with high and low Ki67 expression, respectively. Patients in these two groups did not differ significantly with regard to age, tumor grade, debulking status, histotype, or stage. Sub-group analysis indicated that the differential effect of Ki67 expression existed exclusively among patients who were suboptimally debulked, with a 5-year survival of 16% vs. 39% (p=0.027) for cases with high vs. low Ki67 expression. There was no difference in survival among optimally debulked patients based on Ki67 expression (43% vs. 48%, p=0.890). Conclusion: Ki67 immunostaining provides robust prognostic information for patients with advanced EOC who are incompletely debulked at primary surgery. This biomarker may define subgroups of patients who would be more likely to benefit from cell-cycle dependent chemotherapy regimens, and may guide the development of future therapeutic strategies. No significant financial relationships to disclose.