Complete Cytoreductive Surgery Is Feasible and Maximizes Survival in Patients with Advanced Epithelial Ovarian Cancer: A Prospective Study

Eisenkop, Scott M.; Friedman, Richard L.; Wang, He-Jing

doi:10.1006/gyno.1998.4955

Cited by 488 publications

(250 citation statements)

References 27 publications

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“…Prior studies have suggested that complete resection of metachronous ovarian metastasis of gastric origin [10,13,21] in the absence of other distant metastasis or from a colorectal site [24] may significantly improve survival. In addition, more recent studies showed a benefit from aggressive surgery for metastatic tumors to the ovary from colorectal cancer [24][25][26][27][28]. In the current study, the survival benefit from aggressive surgery was present only in patients with colorectal cancers, not in patients with gastric cancers (Table 4).…”

Section: Discussionmentioning

confidence: 44%

The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

Kim

et al. 2010

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Discussionmentioning

confidence: 44%

The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

Kim

et al. 2010

European Journal of Obstetrics & Gynecology and Reproductiv

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“…9,19 The median estimated blood loss was 600 mL (95% confidence interval [95% CI], 587-854 mL) and the mean number of transfusions was 2.1 U (95% CI, 1.5-2.7 U). No transfusions were given to 45% of the cohort.…”

Section: Resultsmentioning

confidence: 99%

“…The 30-day mortality rate for women undergoing primary surgery for ovarian carcinoma ranged from 1-3%. [7][8][9][10] In addition, major morbidity as reported by these studies includes cardiac failure, wound dehiscence, hemorrhage requiring reoperation, and prolonged ileus. Considering that patients who undergo suboptimal debulking derive minimal benefit from surgical debulking, it would appear prudent to identify these patients preoperatively to offer them an alternate approach to the current standard of care.…”

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confidence: 99%

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Dowdy

Mullany

Brandt

et al. 2004

Cancer

169

100

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BACKGROUNDComputed tomography (CT) scans of the abdomen and pelvis may predict which patients with ovarian carcinoma can undergo optimal cytoreduction at primary surgery. Previous studies have demonstrated that patients with ovarian carcinoma had optimal cytoreduction rates ranging from 50–60%. The authors sought to determine whether these findings applied to a surgical practice with a higher rate of optimal debulking. A predictive model using CT scanning and CA 125 values would allow the authors to determine which patients would be more appropriately treated with neoadjuvant chemotherapy.METHODSPreoperative CT scans for patients with Stage III/IV ovarian carcinoma (according to the staging system of the International Federation of Gynecology and Obstetrics) who were treated between 1996 and 2001 were evaluated retrospectively by 2 radiologists for 17 criteria evaluating the extent of disease. Clinical data were extracted from medical records. Residual tumors measuring ≥ 1 cm were considered suboptimal. Logistic regression was used to evaluate which criteria correlated with optimal cytoreduction.RESULTSEighty‐seven patients were identified retrospectively who met entry criteria and had preoperative CT scans of sufficient diagnostic quality. Sixty‐two patients (71%) received optimal cytoreductive surgery and 45 (52%) required aggressive surgical procedures. In a multivariate model, only diffuse peritoneal thickening (DPT) independently predicted suboptimal surgical resection (P = 0.016). However, a model using both DPT and ascites on most CT scans had a positive predictive value of 68% and a sensitivity of 52% for predicting suboptimal cytoreduction.CONCLUSIONSThe presence of DPT and large‐volume ascites was associated with a very low rate of optimal cytoreduction (32%) in a surgical practice. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction. Cancer 2004. © 2004 American Cancer Society.

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Section: Introductionmentioning

confidence: 99%

“…The significance of complete, as opposed to optimal, cytoreduction has also been appreciated [6]. Multiple authors have reported five-year survival rates between 40 and 50% for patients with microscopic residual disease [1,6]. The rate of complete cytoreduction and associated survival has been shown to be both surgeon and institution dependent [7,8].…”

Section: Introductionmentioning

confidence: 99%

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Dowdy

Loewen

Aletti

et al. 2008

Gynecologic Oncology

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Objective-To describe the technique of diaphragmatic peritonectomy (DP) for ovarian cancer cytoreduction and to assess associated morbidity.Methods-Retrospective review yielded 56 patients who underwent DP as part of a cytoreductive procedure for primary or recurrent ovarian cancer between 1988 and 2004. Patients who underwent diaphragmatic resection, removal of diaphragmatic implants with CUSA, cautery, curette, or finger fracture, and patients with pseudomyxoma were excluded from analysis.Results-DP was performed as a component of primary or secondary cytoreduction in 37 (66%) and 19 (34%) patients, respectively. Extended procedures including bowel resection, hepatic resection, splenectomy, or radical hysterectomy were performed with DP in 47 patients (82%). Resection of all disease > 1 cm was achieved in 95% (microscopic residuum in 43%). For those undergoing primary cytoreduction, median survival was 59 months and 5-year survival was 49% with median follow-up of 34 months. When performed for recurrent ovarian carcinoma, 5-year survival was 16% and median survival was 23 months. No intra-operative complications could be specifically attributed to DP. Post-operative complications included a 30% rate of pleural effusion which was associated with entry into the pleural space during DP (p<0.0001); thoracentesis was required in 12.5%.Conclusions-Diaphragmatic metastases are a common obstacle to optimal cytoreduction for patients with ovarian cancer. When necessary, utilizing DP in concert with other extended procedures to obtain maximal cytoreduction is associated with excellent survival. It should be recognized that DP is associated with an increased incidence of post-operative pleural effusion, particularly when the pleural space is entered.

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Complete Cytoreductive Surgery Is Feasible and Maximizes Survival in Patients with Advanced Epithelial Ovarian Cancer: A Prospective Study

Cited by 488 publications

References 27 publications

The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

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