Advanced Cytoreductive Surgery Workshop Report

Abstract

The Advanced Course in Cytoreductive Surgery for Ovarian Cancer and Gynecologic Peritoneal Surface Malignancies was held at the University of California Irvine Medical Center on November 4-5, 2011. The course director was Dr Robert E. Bristow, the Philip J. DiSaia Chair and Division Director of Gynecologic Oncology. Meeting information was distributed via e-mail blasts by the International Gynecologic Cancer Society. The workshop was comprised of didactic modules, a cadaver laboratory, and heated intraperitoneal chemotherapy demonstration. This was a not-for-profit workshop, and registration fees were used to support course faculty travel to UC Irvine and pay for the cadavers.

Characteristics and outcome of the COEUR Canadian validation cohort for ovarian cancer biomarkers

“…The amount of residual disease (RD) or cytoreduction efficiency was difficult to collect due to lack of consistent reporting in the biobank data (66%). To standardize this data we translated the RD amount as non-optimal cytoreduction when RD was > 1 cm as per 2012 clinical standards [ 6 ]. When only ‘optimal’ cytoreduction was collected from biobanks, we could not translate this information into the measurable variable (> 1 cm or 1–2 cm) since the standard has changed over time and also may not be the same in all institutions.…”

Fifth annual workshop of cytoreductive surgery for advanced ovarian cancer and peritoneal surface malignancies

“…The third and final period of the evolution of the concept of cytoreduction and inherent validity in advanced disease encompasses the 1973 report by McGrath on the survival advantage afforded patients with abdominal Burkitt’s lymphoma who underwent extensive disease resections [30], the landmark study by Griffiths from 1974 in which the surgeon reported that among 102 consecutive cases of advanced ovarian cancer, those patients in whom residual disease greater than 1.5 cm in maximal diameter was left in the abdominal cavity were invariably dead within 2 years as compared to the 20 % 5-year survival rate conferred by tumor residuals under 1.5 cm [31], and finally, the watershed event by Bristow et al in which a meta-analysis of 81 ovarian cancer cohorts (nearly 7,000 patients) treated with platinum-based chemotherapy demonstrated that the most important determinant of survival was maximal cytoreduction with each 10 % increase in tumor resection associated with a 5.5 % increase in median survival time [32]. This chronology appears in greater detail in our first Workshop Report [24]. The First Law of Cytoreduction is concerned with the temporal aspects and holds that the evolution traversed three distinct periods involving oophorectomy, surgery in the setting of metastatic disease, and validation of surgical effort to bring the residual disease volume to no visible tumor (ie, R 0 ).…”

“…Introduced by faculty member, KS Tewari, at the 1st Workshop on November 4, 2011, the concept of cytoreduction for ovarian cancer evolved over three periods encompassing nearly 200 years [24]. Beginning with Ephraim McDowell’s (1771-1830) first oophorectomy performed on 45-year old Jane Todd Crawford (1763-1842) on his kitchen table on Christmas Day, 1809, a surgical masterpiece was created for which McDowell was named the Father of Abdominal Surgery [25].…”

“…The rationale for cytoreduction is supported by several hypotheses concerning intrinsic tumor drug resistance (which is independently described by both the Goldie Coldman hypothesis for acquisition of somatic mutations and Bayes Theorem) by which large areas of disease harboring chemoresistant clones are resected [24]. Increased tumor growth fraction (described according to Gompertzian cell kinetics) occurring after surgery shuttles resting phase G 0 cells into the cell cycle and thereby makes them more vulnerable to cycle-specific antineoplastic agents.…”

“…3f). Regional therapy exploits both the prolonged confinement of disease within the peritoneal cavity and the steep dose-response relationship observed for many cytotoxic agents, allowing for a slower rate of drug clearance from the peritoneal to systemic compartments, ultimately creating a concentration differential across the peritoneal-plasma barrier that favors the peritoneal cavity [24]. …”