Does neoadjuvant chemotherapy decrease the risk of hospital readmission following debulking surgery?

Worley, Michael J.; Guseh, Stephanie H.; Rauh‐Hain, J. Alejandro; Williams, Kristina; Muto, Michael G.; Feltmate, Colleen M.; Berkowitz, Ross S.; Horowitz, Neil S.

doi:10.1016/j.ygyno.2013.01.012

Cited by 31 publications

(19 citation statements)

References 23 publications

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“…Subsequently, 11 studies were excluded in which the FIGO stages were III and IV [3, 13-20] or chemotherapies were administered intraperitoneally [21, 22]. Eventually, 12 studies were included in this meta-analysis, comprising 1 RCT [4], 9 cohort studies [1, 11, 23-29], and 2 case-control studies [5, 30]. The flow diagram of study selection is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 12 studies, 5 studies were arranged with a total of 6 chemotherapeutic cycles [1, 4, 5, 23, 25], including 1,606 patients, with 705 for NAC and 901 for PDS. The characteristics of trials included in this systematic review and meta-analysis are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 5 of the 12 studies provided the information on postoperative adverse reactions [1, 4, 23-25]. All of them were graded according to the Memorial Sloan-Kettering Cancer Center Surgical Secondary Events Grading System.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, for the current studies, NAC followed by IDS was still chosen for older patients with more comorbidities, poorer performance status, and later FIGO stage compared with PDS followed by chemotherapy [1, 3-5, 9-16, 18-20, 23-30]. Although under the impact of the huge selection biases, most of the studies proved that NAC followed by IDS could reduce the operation time, lessen the amount of blood loss, shorten the postoperative stay time, and even reduce the postoperative adverse reactions.…”

Section: Discussionmentioning

confidence: 99%

“…Although under the impact of the huge selection biases, most of the studies proved that NAC followed by IDS could reduce the operation time, lessen the amount of blood loss, shorten the postoperative stay time, and even reduce the postoperative adverse reactions. However, controversy still existed regarding the survival outcomes of the groups [4, 5, 11, 23-30]. Therefore, it is still unclear which kind of patients can benefit more from NAC followed by IDS.…”

Section: Discussionmentioning

confidence: 99%

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Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun

Xie

Wang

et al. 2017

Gynecol Obstet Invest

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Background/Aim: This study aimed to compare neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) with primary debulking surgery (PDS) followed by chemotherapy in patients with advanced ovarian carcinoma International Federation of Gynecology and Obstetrics (FIGO) stages IIIc and IV. Methods: PubMed, the Cochrane Library, and manual searches were applied to discriminate potentially eligible studies published before June 30, 2016. Results: A total of 12 comparative studies were finally included; 1,372 patients underwent NAC followed by IDS, and 2,680 patients underwent PDS followed by chemotherapy. For overall pooled estimates, significant between-trial differences were found in the optimal debulking rate, grade 3–5 postoperative adverse reactions, and median overall survival (OS), but no difference was found in the median progression-free survival (PFS). Moreover, a significantly higher incidence was identified in major infections, vascular events, and wound complications for patients in the PDS group. Conclusions: This study suggested that NAC followed by IDS could improve the optimal debulking rate and decrease the postoperative adverse reactions for the current studies, but whether it could improve the OS and PFS compared with PDS followed by chemotherapy in patients with ovarian carcinoma FIGO stages IIIc and IV were still needed to be verified by conducting more randomized controlled trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun

Xie

Wang

et al. 2017

Gynecol Obstet Invest

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Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy in High-Grade Epithelial Ovarian Cancer

Rauh-Hain,

Melamed,

Pareja

et al. 2024

JAMA Netw Open

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ImportanceDespite the absence of high-quality evidence of its safety and effectiveness, minimally invasive surgery (MIS) is increasingly used to treat advanced epithelial ovarian cancer (EOC).ObjectiveTo assess the feasibility of conducting a full-scale randomized clinical trial (RCT) designed to compare the efficacy of MIS vs laparotomy in patients with advanced-stage EOC and a complete or partial response to neoadjuvant chemotherapy (NACT).Design, Setting, and ParticipantsThis lead-in pilot phase of LANCE (Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy), an international, open-label, noninferiority RCT, opened to enrollment in September 2020 and enrolled the 100th eligible patient in February 2023. It was conducted at 11 academic cancer centers in North America and Europe. Participants were adults with stage IIIC or IV epithelial ovarian, fallopian, or primary peritoneal carcinoma who had normal cancer antigen 125 levels and at least a partial radiologic response after 3 to 4 cycles of NACT. Patients were randomly assigned to receive either interval cytoreductive surgery performed using MIS or laparotomy. Data analysis was based on the evaluable population.InterventionsThe MIS arm underwent laparoscopic or robotic surgery, vs laparotomy for the control arm. Resection of all visible tumor was attempted, and conversion from MIS to laparotomy was performed when necessary to attain complete resection.Main Outcomes and MeasuresTrial feasibility was defined by 3 primary end points: patient accrual rate of at least 5.6 patients per month by the last month of the lead-in pilot phase, conversion from MIS to laparotomy in less than 25% of patients, and a difference in complete gross resection rates of fewer than 20 percentage points between study arms.ResultsOne hundred women (median [IQR] age, 63 [39-82] years) were included, of whom 49 were randomly assigned to MIS and 51 to laparotomy; 95 were evaluable for surgical outcomes. Most patients (34 [67%] in the laparotomy arm, and 33 [67%] in the MIS arm) had stage IIIC cancer. The monthly accrual rate reached 5.9 patients per month in the final month of the study. Six of 48 evaluable patients (12.5%; 95% CI, 4.7%-25.2%) assigned to MIS underwent conversion to laparotomy. Surgeons achieved a complete gross resection rate in 42 of 48 evaluable patients (88%) assigned to MIS and in 39 of 47 patients (83%) assigned to laparotomy (difference, 4.5 [95% CI, −9.7 to 18.8] percentage points).Conclusions and RelevanceResults of this lead-in pilot study indicated the feasibility of the LANCE RCT to compare the oncological outcomes of MIS vs laparotomy.Trial RegistrationClinicalTrials.gov Identifier: NCT04575935

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What is the optimal treatment for obese patients with advanced ovarian carcinoma?

Worley

Guseh

Rauh‐Hain

et al. 2014

American Journal of Obstetrics and Gynecology

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Does neoadjuvant chemotherapy decrease the risk of hospital readmission following debulking surgery?

Cited by 31 publications

References 23 publications

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy in High-Grade Epithelial Ovarian Cancer

What is the optimal treatment for obese patients with advanced ovarian carcinoma?

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