Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer

Abstract

Background Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. Objectives To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult women with advanced primary epithelial ovarian cancer. Data collection and analysis Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed. Main results One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 women with stage IIIC advanced epithelial ovarian cancer who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among women receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 women with carcinomatosis, those who underwent ultra-radical surgery had significantly better disease specific survival than women who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias. Authors’ conclusions We found only low quality evidence comparing ultra-radical and standard surgery in women with advanced ovarian cancer and carcinomatosis. The evidence suggested that ultra-radical surgery may result in better survival. It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery. In order to determine the role of ultra-radical surgery in the management of advanced stage ovarian cancer, a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would ...

Total Infragastric Omentectomy Including the Vascular Perigastric Arcade in Patients With Advanced Serous Ovarian Tumors

“…22Y26 The standard surgery of AEOC encompasses hysterectomy, bilateral salpingo-oophorectomy, total omentectomy (including the supracolic omentum), appendicectomy, pelvic and para-aortic lymphadenectomy, peritoneal staging, and resection of all visible lesions, with the objective of achieving a complete resection. 10,11,27,28 Debulking surgery to no visible disease is associated with the greatest improvement in subsequent survival. 7,29 However, the surgical effort required seems to be diversely implemented, with striking variations in the cytoreduction rate 11,30 In a survey of surgical practice of gynecological oncologists in the United Kingdom about the primary treatment of AEOC, almost 50% of the surgeons did not perform a ''total'' supracolic omentectomy.…”

“…10,11,27,28 Debulking surgery to no visible disease is associated with the greatest improvement in subsequent survival. 7,29 However, the surgical effort required seems to be diversely implemented, with striking variations in the cytoreduction rate 11,30 In a survey of surgical practice of gynecological oncologists in the United Kingdom about the primary treatment of AEOC, almost 50% of the surgeons did not perform a ''total'' supracolic omentectomy. 4 In another study, 19% of gynecological oncology centers from 18 European countries performed only infracolic omentectomy in AEOC.…”

Patient-Reported Outcomes After Extensive (Ultraradical) Surgery for Ovarian Cancer: Results From a Prospective Longitudinal Feasibility Study

“…6,7 Data from 2 Cochrane reviews suggest that complete cytoreduction leads to the best survival. 8,9 However, controversy remains as to whether the better outcome is caused by the technical proficiency of surgeons or the tumor biology that makes the tumor easier for removal. 10, 11 Eisenhauer et al 7 however suggest in their retrospective study that the tumor biology can be overcome by extending the resection to the upper abdomen.…”

Optimizing the primary treatment of patients with advanced ovarian cancer

“…Обращает на себя внимание то, что оба исследования подвергаются критике из-за сомнений в адекватности предложенного пациенткам хирур-гического вмешательства [22]. Расширение объема операций также влечет за собой повышение числа осложнений, влияние которых на качество жизни па-циенток не было адекватно оценено ни в одной работе [23]. Возможность персонализации подходов к хирур-гическому лечению больных распространенным РЯ остается одним из приоритетных и малоизученных научных направлений.…”