Cytoreductive surgery in ovarian carcinoma: Feasibility and morbidity

Heintz, A. Peter M.; Hacker, N F; Berek, J. S.

doi:10.1016/0020-7292(87)90198-6

Cited by 66 publications

(62 citation statements)

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“…The 30-day mortality rate for women undergoing primary surgery for ovarian carcinoma ranged from 1-3%. [7][8][9][10] In addition, major morbidity as reported by these studies includes cardiac failure, wound dehiscence, hemorrhage requiring reoperation, and prolonged ileus. Considering that patients who undergo suboptimal debulking derive minimal benefit from surgical debulking, it would appear prudent to identify these patients preoperatively to offer them an alternate approach to the current standard of care.…”

mentioning

confidence: 99%

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Dowdy

Mullany

Brandt

et al. 2004

Cancer

167

100

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BACKGROUNDComputed tomography (CT) scans of the abdomen and pelvis may predict which patients with ovarian carcinoma can undergo optimal cytoreduction at primary surgery. Previous studies have demonstrated that patients with ovarian carcinoma had optimal cytoreduction rates ranging from 50–60%. The authors sought to determine whether these findings applied to a surgical practice with a higher rate of optimal debulking. A predictive model using CT scanning and CA 125 values would allow the authors to determine which patients would be more appropriately treated with neoadjuvant chemotherapy.METHODSPreoperative CT scans for patients with Stage III/IV ovarian carcinoma (according to the staging system of the International Federation of Gynecology and Obstetrics) who were treated between 1996 and 2001 were evaluated retrospectively by 2 radiologists for 17 criteria evaluating the extent of disease. Clinical data were extracted from medical records. Residual tumors measuring ≥ 1 cm were considered suboptimal. Logistic regression was used to evaluate which criteria correlated with optimal cytoreduction.RESULTSEighty‐seven patients were identified retrospectively who met entry criteria and had preoperative CT scans of sufficient diagnostic quality. Sixty‐two patients (71%) received optimal cytoreductive surgery and 45 (52%) required aggressive surgical procedures. In a multivariate model, only diffuse peritoneal thickening (DPT) independently predicted suboptimal surgical resection (P = 0.016). However, a model using both DPT and ascites on most CT scans had a positive predictive value of 68% and a sensitivity of 52% for predicting suboptimal cytoreduction.CONCLUSIONSThe presence of DPT and large‐volume ascites was associated with a very low rate of optimal cytoreduction (32%) in a surgical practice. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction. Cancer 2004. © 2004 American Cancer Society.

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confidence: 99%

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Dowdy

Mullany

Brandt

et al. 2004

Cancer

167

100

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“…However, this analysis is based on data of patients treated between 1996 and 2003. In a previous study on this cohort we indicated that the results of semi-specialized and tertiary care settings were better than the results in general hospitals, but still lagged behind the outcomes described in literature [6][7][8]. The percentage of adequately staged patients should increase to 90% and the percentage of patients optimally debulked can be improved to at least 70% according to the literature [7,8].…”

Section: Discussionmentioning

confidence: 76%

“…In addition, we evaluated a scenario in which the percentage of adequately staged and optimally debulked patients in tertiary care settings was assumed to be 90% and 70%, respectively. These rates have been considered feasible in specialized settings [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…We observed that patients treated in (semi-)specialized hospital settings significantly more often received adequate surgery and survival was better in these settings [6]. Nevertheless, even in (semi-)specialized settings surgical outcomes were inferior to results described in literature [7,8]. Only high-volume specialized gynecologists achieved outcomes that were comparable to the results in specialized settings in other countries.…”

Section: Introductionmentioning

confidence: 99%

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Is centralization of ovarian cancer care warranted?

Greving

Vernooij

Heintz

et al. 2009

Gynecologic Oncology

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“…In ovarian cancer, there has been good evidence of an inverse relationship between residual tumor diameter and survival. [17][18][19] "Optimal debulking" for systemic chemotherapy has come to denote residual disease of Յ1.5-2.0 cm in diameter. 18 Therefore, application of Avp53 after assiduous resection of the peritoneal tumor may achieve complete eradication of the tumor in the peritoneal cavity and significantly improve survival.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal gene therapy with adenoviral-mediated p53 tumor suppressor gene for ovarian cancer model in nude mouse

et al. 1999

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In an effort to develop a method for better local control of advanced ovarian cancers, we have established a peritoneal tumor model of ovarian cancer in the nude mouse and applied intraperitoneal gene therapy with the recombinant adenoviral-mediated wild-type p53 tumor suppressor gene (Avp53). The results indicate that: (a) the recombinant adenoviral vector system effectively infected the tumor and normal cells in the peritoneal cavity; and (b) Avp53 treatment effectively suppressed the growth of peritoneal tumors and prolonged the survival of the treated group, especially when the tumor burden was less. These results suggest that intraperitoneal gene therapy using Avp53 is potentially useful as an adjuvant therapeutic modality in human ovarian cancer.

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Cytoreductive surgery in ovarian carcinoma: Feasibility and morbidity

Cited by 66 publications

References 0 publications

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Is centralization of ovarian cancer care warranted?

Intraperitoneal gene therapy with adenoviral-mediated p53 tumor suppressor gene for ovarian cancer model in nude mouse

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