Effect of Surgical Debulking on Survival in Stage IV Ovarian Cancer

Liu, Paul C.; Benjamin, Ivor; Morgan, Mark A.; King, Stephanie; Mikuta, John J.; Rubin, Stephen C.

doi:10.1006/gyno.1996.4396

Cited by 91 publications

(41 citation statements)

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“…Early reports suggested that even with stage IV disease, optimal cytoreduction may be associated with improved outcome. [22][23][24] However, many of these reports defined "optimal" cytoreduction as residual disease of less than 2 cm. Furthermore, these early reports identified pleural cavity disease by positive cytology alone.…”

Section: Primary Diseasementioning

confidence: 99%

Maximal cytoreductive effort in epithelial ovarian cancer surgery

2010

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The surgical management of advanced epithelial ovarian cancer involves cytoreduction, or removal of grossly-evident tumor. Residual disease after surgical cytoreduction of ovarian cancer has been shown to be strongly associated with survival. The goal of surgery is "optimal" surgical cytoreduction, which is generally defined as residual disease of 1 cm or less. However, the designation of "optimal" surgical cytoreduction has evolved to include maximal surgical effort and no gross residual disease. In order to achieve this, more aggressive surgical procedures such as rectosigmoidectomy, diaphragm peritonectomy, partial liver resection, and video-assisted thoracic surgery are reported and increasingly utilized in the surgical management of advanced ovarian cancer. The role of maximal surgical effort also extends to the recurrent setting where the goal of surgery should be complete cytoreduction. Patient selection is important in identifying appropriate candidates for surgical cytoreduction in the recurrent setting. The purpose of this article is to review the role of maximum surgical effort in primary and recurrent ovarian cancer.

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Section: Primary Diseasementioning

confidence: 99%

Maximal cytoreductive effort in epithelial ovarian cancer surgery

2010

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“…Patients with an optimal tumor cytoreduction (residual lesions smaller than 1 cm) have a significant longer survival (almost two times the median survival) than patients with larger residual lesions [1][2][3][4][5]. This holds true even for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease [6][7][8][9][10]. Patients in whom all macroscopic tumor is resected do have the longest survival.…”

Section: Opinion Statementmentioning

confidence: 99%

Advanced ovarian cancer

2001

Curr. Treat. Options in Oncol.

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Ovarian cancer spreads early in the disease into the abdomen. An en bloc resection of the tumor, according to surgical principle, is not possible in patients with high-stage ovarian cancer. At surgery, large pelvic tumor lesions are found together with multiple tumor lesions involving the omentum, bowel, and mesentery together with a diffuse peritoneal carcinomatosis and diaphragmatic involvement. A multimodality approach with cytoreductive surgery and taxol platinum-based chemotherapy is therefore the mainstay of treatment of advanced ovarian cancer. The size of residual disease after surgery is one of the most important prognostic factors for survival. Patients with an optimal tumor cytoreduction (residual lesions smaller than 1 cm) have a significant longer survival (almost two times the median survival) than patients with larger residual lesions. This holds true even for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Patients in whom all macroscopic tumor is resected do have the longest survival. The 2-year survival of patients with a radical resection of all macroscopic tumors is 80%, in contrast to less than 22% for the patients with lesions larger than 2 cm. An optimal primary cytoreductive surgery can generally be performed in 30% to 50% of patients. Only in more experienced gynecologic oncology centers is the percentage as high as 85%, but sometimes at the cost of an increased morbidity and even mortality. The worse prognosis of the patients with a suboptimal primary cytoreductive surgery can be improved by an interval cytoreductive surgery after platinum-containing induction chemotherapy. The median survival and progression-free survivals are significantly lengthened by cytoreductive surgery. After more than 5-years follow-up there is still a significant survival benefit: the 5-year survival of the surgery patients was 24% versus 13% for the no-surgery patients (P = 0.0032). All patients, including those with unfavorable prognostic factors (stage IV disease, peritonitis carcinomatosis, or ascites at primary surgery), and even patients with stable disease after induction chemotherapy, seem to benefit from interval cytoreductive surgery. The increase in progression-free survival and overall survival does outweigh the morbidity associated with interval debulking surgery, which is not different from those associated with primary surgery.

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“…Optimal debulking is independent predictor of survival by multivariate analysis. Liu et al 33 -IV 2% 13 d Median survival with optimal debulking 37 mo vs 11 mo with suboptimal residual disease (P ϭ .03). Janicke et al 34 18 mo IV -19 d Survival 29 vs 9 months for no residual vs Ͻ 2 cm residual disease (P ϭ 0.004).…”

Section: Surgical Paradigmsmentioning

confidence: 98%