Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach

Dennis, S.; Franklin, Corinna C.; Levine, Douglas A.; Akselrod, Faina; Sabbatini, Paul; Jarnagin, William R.; DeMatteo, Ronald P.; Poynor, Elizabeth; Abu‐Rustum, Nadeem R.; Barakat, Richard R.

doi:10.1016/j.ygyno.2004.01.029

Cited by 294 publications

(161 citation statements)

References 16 publications

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“…In our series we could confirm the significant prognostic value of the long established factors of post-operative residual masses and initial tumor stage [18][19][20]. We could show that diffuse peritoneal carcinomatosis is very common at the time of initial presentation of ovarian cancer (76% of total patients).…”

Section: Discussionsupporting

confidence: 72%

Intra‐abdominal tumor dissemination pattern and surgical outcome in 214 patients with primary ovarian cancer

Sehouli

Senyuva

Fotopoulou

et al. 2009

Journal of Surgical Oncology

111

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Introduction: We performed a systematic evaluation of tumor pattern and surgical outcome in 214 consecutive patients with primary ovarian cancer. Methods: Based on the surgical and histological reports we retrospectively analyzed tumor localizations, surgical and clinical outcome. Coxregression analysis was performed to identify independent predictors of complete tumor resection and mortality. Results: Median age was 57.7 years (range: 20-88). FIGO-stage-I was classified in 8.4% and IV in 16.4% of all patients. The peritoneum was the structure most affected (76%) followed by the colon (52%) and diaphragm (44%). Upper abdominal tumor involvement was associated with a significantly higher rate of lymph node metastasis and a significantly lower rate of complete surgical tumor resection, when compared to patients with tumor limited to the lower abdomen. Median overall survival was 56; 61 and 27 months for patients with tumor load in the upper, lower and whole abdomen respectively (P < 0.05). Conclusions: The intraoperative tumor dissemination pattern and the post-operative tumor residuals are decisive for the prognosis in primary ovarian cancer. There is an urgent need to use a systematic and standardized tumor documentation protocols to define the predictive and prognostic role of specific tumor pattern and to compare the surgical outcomes of different tumor centers.

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Section: Discussionsupporting

confidence: 72%

Intra‐abdominal tumor dissemination pattern and surgical outcome in 214 patients with primary ovarian cancer

Sehouli

Senyuva

Fotopoulou

et al. 2009

Journal of Surgical Oncology

111

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“…The clear association between optimal cytoreduction and improved survival in patients with advanced ovarian cancer has resulted in the adoption of techniques to address upper abdominal disease in many centers [25]. We and others have provided evidence that survival benefits are not compromised when radical procedures, including diaphragm resection, are necessary to achieve optimal cytoreduction [1,21,26].…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, the rate and type of complications observed was consistent with that seen after aggressive cytoreduction without DP. We currently utilize this procedure at more than twice the rate of a decade ago for patients with primary ovarian cancer, and as noted in other practices have witnessed a resultant increase in optimal cytoreduction rates [25].…”

Section: Discussionmentioning

confidence: 99%

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Dowdy

Loewen

Aletti

et al. 2008

Gynecologic Oncology

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Objective-To describe the technique of diaphragmatic peritonectomy (DP) for ovarian cancer cytoreduction and to assess associated morbidity.Methods-Retrospective review yielded 56 patients who underwent DP as part of a cytoreductive procedure for primary or recurrent ovarian cancer between 1988 and 2004. Patients who underwent diaphragmatic resection, removal of diaphragmatic implants with CUSA, cautery, curette, or finger fracture, and patients with pseudomyxoma were excluded from analysis.Results-DP was performed as a component of primary or secondary cytoreduction in 37 (66%) and 19 (34%) patients, respectively. Extended procedures including bowel resection, hepatic resection, splenectomy, or radical hysterectomy were performed with DP in 47 patients (82%). Resection of all disease > 1 cm was achieved in 95% (microscopic residuum in 43%). For those undergoing primary cytoreduction, median survival was 59 months and 5-year survival was 49% with median follow-up of 34 months. When performed for recurrent ovarian carcinoma, 5-year survival was 16% and median survival was 23 months. No intra-operative complications could be specifically attributed to DP. Post-operative complications included a 30% rate of pleural effusion which was associated with entry into the pleural space during DP (p<0.0001); thoracentesis was required in 12.5%.Conclusions-Diaphragmatic metastases are a common obstacle to optimal cytoreduction for patients with ovarian cancer. When necessary, utilizing DP in concert with other extended procedures to obtain maximal cytoreduction is associated with excellent survival. It should be recognized that DP is associated with an increased incidence of post-operative pleural effusion, particularly when the pleural space is entered.

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“…Los estándares actuales demandan que el cirujano remueva tumor más allá de la pelvis, en particular en el abdomen superior. Es por ello que la cirugía ultraradical implica efectuar resecciones intestinales únicas o múltiples, remover el diafragma, realizar esplenectomía, pancreatectomía distal, hepatectomía parcial, por nombrar las más frecuentes (10,11). Tal complejidad quirúrgica demanda entrenamiento adicional del ginecólogo oncólogo y exposición a un número mínimo de casos al año (a fin de minimizar las complicaciones), mayor tiempo en pabellón (alrededor de 7 a 9 horas por cirugía en equipos expertos), necesidad de uso de insumos quirúrgicos de mayor costo (ej.…”

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“…Tal complejidad quirúrgica demanda entrenamiento adicional del ginecólogo oncólogo y exposición a un número mínimo de casos al año (a fin de minimizar las complicaciones), mayor tiempo en pabellón (alrededor de 7 a 9 horas por cirugía en equipos expertos), necesidad de uso de insumos quirúrgicos de mayor costo (ej. suturas mecánicas intestinales), de contar con el apoyo multidisciplinario de otros especialistas para el manejo perioperatorio de complicaciones inherentes a la complejidad de estos casos y donde el cuidado intensivo y el apoyo nutricional juegan un papel central (11).…”

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GES en cáncer de ovario epitelial: un avance sanitario necesario pero no exento de riesgos y dificultades futuras

2013

Rev. chil. obstet. ginecol.

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Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach

Cited by 294 publications

References 16 publications

Intra‐abdominal tumor dissemination pattern and surgical outcome in 214 patients with primary ovarian cancer

Intra‐abdominal tumor dissemination pattern and surgical outcome in 214 patients with primary ovarian cancer

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

GES en cáncer de ovario epitelial: un avance sanitario necesario pero no exento de riesgos y dificultades futuras

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