Long-term survival in advanced ovarian carcinoma following cytoreductive surgery with standard peritonectomy procedures

Abstract

The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.

Combined Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Advanced Ovarian Cancer

“…The rate of postoperative complications in cytoreductive surgery combined with HIPEC does not usually exceed 30-35% although a morbidity rate of 54% has been referred in one study (Elias et al, 2001). The same high rate of morbidity has been recorded in patients with ovarian cancer treated with cytoreduction and perioperative intraperitoneal chemotherapy Tentes et al, 2006;Raspagliesi et al, 2006;Di Giorgio et al, 2008;Tentes et al, 2010). In properly selected patients the mortality rate is not high and does not exceed 5% (Piso et al, 2004;Raspagliesi et al, 2006;Tentes et al, 2010).…”

“…In properly selected patients the mortality rate is not high and does not exceed 5% (Piso et al, 2004;Raspagliesi et al, 2006;Tentes et al, 2010). However, if the patients are not properly selected the mortality rate increases dramatically (Tentes et al, 2006). In non-properly selected patients the age > 65 years and the performance status were found to be related to mortality, in addition to extensive peritoneal carcinomatosis that was not completely cytoreduced (Table 1 …”

“…The completeness of cytoreduction score is the most significant prognostic indicator of survival in patients with pseudomyxoma peritonei (Sugarbaker, 2006;Miner et al, 2005;Baratti et al, 2007) peritoneal mesothelioma (Yan et al 2007;Sebbag et al, 2000;Brigand et al, 2006;Deraco et al, 2006), colorectal cancer with peritoneal carcinomatosis Gomez-Portilla et al, 1999) gastric cancer with peritoneal carcinomatosis (Yonemura et al, 2003), and peritoneal sarcomatosis (Rossi et al, 2004;Berthet et al, 1999). The completeness of cytoreduction score in advanced ovarian cancer has been demonstrated to be a significant prognostic indicator of survival Tentes et al, 2006;Piso et al, 2004;Raspagliesi et al, 2006;Di Giorgio et al, 2008 (Tentes et al, 2006). Patients with poor performance status can not tolerate extensive surgery such as cytoreductive surgery because of increased morbidity and hospital mortality.…”

“…Meta-analyses have documented the same finding (Hunter et al, 1992;Bristow et al, 2002) but no prospective trial has been performed. The feasibility of complete cytoreduction using standard peritonectomy procedures in ovarian cancer is 78.4% (Tentes et al, 2006;Chi et al, 2004).…”

“…In ovarian cancer the residual tumor is the most significant indicator for long-term survival (Hacker et al, 1983;Neijt et al, 1991;Hoskins et al, 1992;Eisenkop et al, 2003;Hunter et al, 1992;Bristow et al, 2002;Tentes et al, 2006;Piso et al, 2004;Raspagliesi et al, 2006;Di Giorgio et al, 2008;Look et al, 2004). Gynecologists oncologists use the terms optimal and suboptimal cytoreduction to define the quality of the surgical result.…”