Interval debulking surgery for advanced epithelial ovarian cancer

Abstract

Background-Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option. Objectives-To assess the effectiveness and complications of IDS for women with advanced stage epithelial ovarian cancer.

Centralisation of services for gynaecological cancer

“…In twenty-three studies (Carney 2002; Chan 2007; Earle 2006; Eisenkop 1992; Engelen 2006; Ghaemmaghami 2010;Grant 1992; Grossi 2002; Ioka 2004; Ioka 2005; Junor 1999;Kehoe 1994; Kumpulainen 2002; Kwon 2008; Macdonald 2005; Mayer 1992; Nguyen 1993; O’Malley 2003; Petignat 2000; Tanner 2008; Tingulstad 2003; Van der Zee 2009;Woodman 1997), the interventions were not clearly defined. In addition, we excluded studies where only the effect of the surgeon was measured.Eight studies (Goff 2006; Goff 2007; Munstedt 2003;Paulsen 2006; Pearl 2002; Petignat 1999; Wolfe 1996; Wolfe 1997) did not report pertinent outcomes defined in this review.Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.Three studies (Bailey 2006; Crawford 2002; Diaz-Montes 2006) did not include a multivariate analysis or use any kind of statistical adjustment for survival outcomes.…”

“…Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.…”

Centralisation of services for gynaecological cancer

“…In twenty-three studies (Carney 2002; Chan 2007; Earle 2006; Eisenkop 1992; Engelen 2006; Ghaemmaghami 2010;Grant 1992; Grossi 2002; Ioka 2004; Ioka 2005; Junor 1999;Kehoe 1994; Kumpulainen 2002; Kwon 2008; Macdonald 2005; Mayer 1992; Nguyen 1993; O’Malley 2003; Petignat 2000; Tanner 2008; Tingulstad 2003; Van der Zee 2009;Woodman 1997), the interventions were not clearly defined. In addition, we excluded studies where only the effect of the surgeon was measured.Eight studies (Goff 2006; Goff 2007; Munstedt 2003;Paulsen 2006; Pearl 2002; Petignat 1999; Wolfe 1996; Wolfe 1997) did not report pertinent outcomes defined in this review.Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.Three studies (Bailey 2006; Crawford 2002; Diaz-Montes 2006) did not include a multivariate analysis or use any kind of statistical adjustment for survival outcomes.…”

“…Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.…”

Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis

“…Over the past decade, the concept of NACT followed by IDS has been accepted as an alternative treatment for patients who were inoperable for PDS. Several studies demonstrated that patients in the NACT group had a lower rate of serious adverse events, post-operative mortality and need for stoma formation [ 40 41 ]. Our study also supports those patients who received NACT followed by IDS had half of the odds of developing post-operative complications compared to those who underwent PDS.…”

“…Our study also supports those patients who received NACT followed by IDS had half of the odds of developing post-operative complications compared to those who underwent PDS. However, the evidence from meta-analysis has shown an inconclusive primary survival difference between PDS and IDS [ 40 ]. As a result, patients treated with IDS should be continuously monitored since emerging studies suggest that complete cytoreduction at time of PDS carries a more favorable prognosis [ 42 43 ].…”

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

“…13 Existing trials have shown conflicting results when further surgery was performed as an interval procedure after suboptimal cytoreduction at primary surgery. 111 Therefore, it seems best to increase attempts at optimizing to lower levels of RD at first surgery. Because there are large disparities between surgeons and centers in their optimal and complete cytoreduction rates, [14][15][16][17] it is worth considering randomizing patients to specialist centers providing more extensive surgery to achieve complete cytoreduction or to nonspecialist centers.…”

Centralisation of services for gynaecological cancer

“…In twenty-three studies (Carney 2002; Chan 2007; Earle 2006; Eisenkop 1992; Engelen 2006; Ghaemmaghami 2010;Grant 1992; Grossi 2002; Ioka 2004; Ioka 2005; Junor 1999;Kehoe 1994; Kumpulainen 2002; Kwon 2008; Macdonald 2005; Mayer 1992; Nguyen 1993; O’Malley 2003; Petignat 2000; Tanner 2008; Tingulstad 2003; Van der Zee 2009;Woodman 1997), the interventions were not clearly defined. In addition, we excluded studies where only the effect of the surgeon was measured.Eight studies (Goff 2006; Goff 2007; Munstedt 2003;Paulsen 2006; Pearl 2002; Petignat 1999; Wolfe 1996; Wolfe 1997) did not report pertinent outcomes defined in this review.Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.Three studies (Bailey 2006; Crawford 2002; Diaz-Montes 2006) did not include a multivariate analysis or use any kind of statistical adjustment for survival outcomes.…”

“…Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.…”

Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis

“…Over the past decade, the concept of NACT followed by IDS has been accepted as an alternative treatment for patients who were inoperable for PDS. Several studies demonstrated that patients in the NACT group had a lower rate of serious adverse events, post-operative mortality and need for stoma formation [ 40 41 ]. Our study also supports those patients who received NACT followed by IDS had half of the odds of developing post-operative complications compared to those who underwent PDS.…”

“…Our study also supports those patients who received NACT followed by IDS had half of the odds of developing post-operative complications compared to those who underwent PDS. However, the evidence from meta-analysis has shown an inconclusive primary survival difference between PDS and IDS [ 40 ]. As a result, patients treated with IDS should be continuously monitored since emerging studies suggest that complete cytoreduction at time of PDS carries a more favorable prognosis [ 42 43 ].…”

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

“…13 Existing trials have shown conflicting results when further surgery was performed as an interval procedure after suboptimal cytoreduction at primary surgery. 111 Therefore, it seems best to increase attempts at optimizing to lower levels of RD at first surgery. Because there are large disparities between surgeons and centers in their optimal and complete cytoreduction rates, [14][15][16][17] it is worth considering randomizing patients to specialist centers providing more extensive surgery to achieve complete cytoreduction or to nonspecialist centers.…”

Centralisation of services for gynaecological cancer

“…In twenty-three studies (Carney 2002; Chan 2007; Earle 2006; Eisenkop 1992; Engelen 2006; Ghaemmaghami 2010;Grant 1992; Grossi 2002; Ioka 2004; Ioka 2005; Junor 1999;Kehoe 1994; Kumpulainen 2002; Kwon 2008; Macdonald 2005; Mayer 1992; Nguyen 1993; O’Malley 2003; Petignat 2000; Tanner 2008; Tingulstad 2003; Van der Zee 2009;Woodman 1997), the interventions were not clearly defined. In addition, we excluded studies where only the effect of the surgeon was measured.Eight studies (Goff 2006; Goff 2007; Munstedt 2003;Paulsen 2006; Pearl 2002; Petignat 1999; Wolfe 1996; Wolfe 1997) did not report pertinent outcomes defined in this review.Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.Three studies (Bailey 2006; Crawford 2002; Diaz-Montes 2006) did not include a multivariate analysis or use any kind of statistical adjustment for survival outcomes.…”

“…Fifteen studies (Bristow 2006; Brolmann 1992; Chan 1999;Du Bois 2009; Giede 2005; Grant 1999; Grant 2000; Lehtovirta 2000; Luesley 2000; Olaitan 2008a; Rich 1993; Savage 2008;Tangjitgamol 2009; Vernooij 2007; Williams 2008) were letters, commentaries, editorials, or reviews.…”

Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis

“…Over the past decade, the concept of NACT followed by IDS has been accepted as an alternative treatment for patients who were inoperable for PDS. Several studies demonstrated that patients in the NACT group had a lower rate of serious adverse events, post-operative mortality and need for stoma formation [ 40 41 ]. Our study also supports those patients who received NACT followed by IDS had half of the odds of developing post-operative complications compared to those who underwent PDS.…”

“…Our study also supports those patients who received NACT followed by IDS had half of the odds of developing post-operative complications compared to those who underwent PDS. However, the evidence from meta-analysis has shown an inconclusive primary survival difference between PDS and IDS [ 40 ]. As a result, patients treated with IDS should be continuously monitored since emerging studies suggest that complete cytoreduction at time of PDS carries a more favorable prognosis [ 42 43 ].…”

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

“…13 Existing trials have shown conflicting results when further surgery was performed as an interval procedure after suboptimal cytoreduction at primary surgery. 111 Therefore, it seems best to increase attempts at optimizing to lower levels of RD at first surgery. Because there are large disparities between surgeons and centers in their optimal and complete cytoreduction rates, [14][15][16][17] it is worth considering randomizing patients to specialist centers providing more extensive surgery to achieve complete cytoreduction or to nonspecialist centers.…”