A collaborative surgical approach to upper and lower abdominal cytoreductive surgery in ovarian cancer

Eng, Oliver S.; Raoof, Mustafa; Blakely, Andrew M.; Lei, Yu; Lee, Stephen J.; Han, Ernest; Wakabayashi, Mark T.; Yuh, Bertram; Lee, Byrne; Dellinger, Thanh H.

doi:10.1002/jso.25120

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…7,9,[20][21][22][23][24][25] Based on previous studies, the mean total survival for patients with stage IV ovarian epithelial cancer varied between 15 and 29 months, with a total survival of 20% at 5 years. 18 In the current study, diseasefree survival was better in patients with peritoneal seeding metastasis; however this result was nonsignificant and the overall survival analysis showed no difference among these patients. In contrast, Bacalbasa et al reported a clear difference in disease free-survival and overall survival in favor of the peritoneal seeding liver metastasis group.…”

Section: Discussioncontrasting

confidence: 64%

“…11 This finding is consistent with the current evidence and demonstrates the safety of the procedure performed by a qualified team. 1,17,18 However, life-threatening complications associated with liver resection have been reported; among them, the most frequent was bleeding followed by liver failure. 19 Studies from 2009 onward have demonstrated an improvement in disease-free survival and total survival of patients undergoing hepatic metastasectomy regardless of the types of primary neoplasias.…”

Section: Discussionmentioning

confidence: 99%

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Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer

Luna‐Abanto

Ruiz

Martínez

et al. 2020

Journal of Gynecologic Surgery

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Objective: The aim of this study was to describe and evaluate the safety of hepatic resections for ovarian cancer liver metastases and the benefit in terms of survival as part of cytoreductive surgery among peritoneal seeding and parenchymal metastases. Materials and Methods: Data were reviewed retrospectively from patients who underwent liver resection as part of cytoreductive surgery for ovarian cancer at the Instituto Nacional de Enfermedades Neoplásicas, in Lima, Perú, patients underwent surgical cytoreduction for ovarian cancer; 39 of these patients had liver resection as part of their surgical treatment, with 9, 17, and 13 patients receiving primary, secondary, and tertiary, resections, respectively. The mean age of the patients was 46, the majority (87%) had stage III/IV ovarian cancer. In addition, 21 patients had parenchymal metastasis resections, and 95% of the patients had Dindo-Clavien I and II grade complications. The 30-day mortality rate was 0. Conclusions: Liver resection for advanced ovarian cancer is a safe procedure for primary up to quaternary cytoreduction and may confer survival benefits to patients. ( J GYNECOL SURG 36:70)

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer

Luna‐Abanto

Ruiz

Martínez

et al. 2020

Journal of Gynecologic Surgery

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“…The final decision regarding resectability and the goal of achieving <0.5 mm of residual tumor tissue are based on exploration to offer the opportunity to investigate hidden spaces (e.g. posterior aspect of the spleen, lesser sac and posterior margin of the liver and diaphragm) (48)(49)(50)(51). Postoperative management requires a large amount of clinical experience to ensure that patients safely overcome postoperative complications and begin adjuvant chemotherapy within 4 weeks of surgery (52)(53)(54).…”

Section: Univariate Analysismentioning

confidence: 99%

Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

Zhang

Zhu

et al. 2022

Oncol Lett

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The present study aimed to evaluate the postoperative complications and the impact of an enhanced recovery programme in patients who underwent primary surgery (including extensive upper abdominal surgery) for epithelial ovarian carcinoma (EOC). All patients with stage I–IV ovarian carcinoma who underwent primary surgery were identified, and postoperative complications were evaluated and graded according to the Clavien-Dindo classification. Of 161 patients, 46 (28.57%) underwent surgical staging, 27 (16.77%) standard cytoreduction, 12 (7.45%) en bloc debulking and 76 (47.20%) extraradical debulking. A total of 157 patients (97.52%) achieved optimal tumor reduction (<1 cm). The mean postoperative hospitalization time was 17.33±11.29 days after completion of the initial postoperative chemotherapy (IPC), and the IPC interval was 16.22±10.09 days. A total of 13 patients (8.07%) had grade 3 complications (9 with wound dehiscence, 3 with digestive tract leakage and 1 with a bladder fistula). A total of 2 patients (1.24%) had grade 4–5 complications [1 patient with severe pneumonia returned to the intensive care unit (ICU) for tracheotomy and respiration rehabilitation; the other patient died of septicemia on day 19]. The multivariate analysis of the preoperative factors revealed that a human epididymis protein 4 (HE4) level of ≥717 pM (P=0.015) and Federation International of Gynecology and Obstetrics (FIGO) stage IV (P=0.004; compared with stage IIIC) were associated with grade 3–5 complications. The bootstrap analysis revealed that a cancer antigen 125 (CA125) level of ≥1,012 U/ml (P=0.034), a HE4 level of ≥717 pM (P=0.007) and FIGO stage IV (P=0.002; compared with stage IIIC) were significantly associated with grade 3–5 complications. Meanwhile, the multivariate analysis of the postoperative factors did not reveal any risk factors associated with grade 3–5 complications; the bootstrap analysis revealed that only transfer to the ICU after surgery (P=0.026) was significantly associated with grade 3–5 complications. In conclusion, the study found that application of enhanced recovery after surgery protocols is feasible in patients with EOC, especially in those undergoing advanced extensive upper abdominal surgery, and CA125, HE4 and FIGO stage IV were related with the occurrence of adverse perioperative outcomes.

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“…We do not know if there was a collaborative surgical approach with a supramesocolic surgical protocol. There is evidence that a multidisciplinary approach [12] with extensive upper abdominal procedures in experienced centers [13] in ovarian cancer impacts OS. We do not know if the surgery performed by all the teams fulfilled these criteria; therefore, OS is biased again at this point.…”

Section: Dear Editormentioning

confidence: 99%

Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease

et al. 2020

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Recent evidence suggested that secondary surgical cytoreduction followed by chemotherapy does not result in longer overall survival in patients with platinum-sensitive recurrent ovarian cancer. This statement is based on a phase III multicenter, randomized clinical trial that lacks a description of the surgical protocol, the surgical technique, and the surgical variables. In a study that evaluates surgical cytoreduction, it is mandatory to assess the grade of cytoreductive surgery achieved (Sugarbaker PH, Langenbeck's Arch Surg 384:576-87, 1999), the extent of disease using PCI (Peritoneal Cancer Index), the technique itself, and the existence of a multidisciplinary approach with extensive upper abdominal procedures in experienced centers

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A collaborative surgical approach to upper and lower abdominal cytoreductive surgery in ovarian cancer

Abstract: A collaborative surgical approach to combined upper and lower abdominal cytoreductive surgery in patients with ovarian cancer should be performed, if needed, to achieve an optimal cytoreduction.

Cited by 9 publications

References 18 publications

Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer

Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer

Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease

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