Synapse - A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary initiative

A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary initiative Journal Article

Authors:	Straubhar, A. M.; Filippova, O. T.; Cowan, R. A.; Lakhman, Y.; Sarasohn, D. M.; Nikolovski, I.; Torrisi, J. M.; Ma, W.; Abu-Rustum, N. R.; Gardner, G. J.; Sonoda, Y.; Zivanovic, O.; Chi, D. S.; Long Roche, K.
Article Title:	A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary initiative
Abstract:	Objective: To describe outcomes using a multimodal algorithm to triage patients with advanced epithelial ovarian cancer (EOC) to primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT). Methods: All patients with EOC treated at our institution from 04/2015–08/2018 were identified. We included patients without contraindication to PDS who underwent prospective calculation of a Resectability (R)-score. A low risk score for suboptimal cytoreduction was defined as ≤6, and a high risk score ≥7. Patients were triaged to laparotomy/PDS, laparoscopic evaluation of resectability (LSC), or NACT depending on R-score. Results: Among 299 participants, 226 (76%) had a low risk score and 73 (24%) a high risk score. For patients with a low risk score, management included laparotomy/PDS, 181 (80%); LSC, 43 (19%) (with subsequent triage: PDS, 31; NACT, 12); and NACT, 2 (1%). For patients with a high risk score, management included laparotomy/PDS, 9 (12%); LSC, 51 (70%) (with subsequent triage: PDS, 28; NACT, 23); and NACT, 13 (18%). Overall, 83% underwent PDS, with a 75% CGR rate and 94% optimal cytoreduction rate. Use of the algorithm resulted in a 31% LSC rate and a 6% rate of suboptimal PDS. Conclusions: The multimodal algorithm led to excellent surgical results; 94% of patients achieved an optimal resection, with a very low rate of suboptimal cytoreduction. © 2020 Elsevier Inc.
Keywords:	adult; aged; major clinical study; splenectomy; advanced cancer; multimodality cancer therapy; adjuvant therapy; cancer patient; antineoplastic agent; hysterectomy; lymph node dissection; laparoscopic surgery; laparotomy; preoperative evaluation; prospective study; salpingooophorectomy; ovarian cancer; cytoreductive surgery; peritoneum cancer; cohort analysis; high risk patient; risk assessment; cancer center; body mass; albumin; cystectomy; scoring system; ovary carcinoma; gastrectomy; liver resection; intestine resection; neoadjuvant chemotherapy; appendectomy; uterine tube carcinoma; cholecystectomy; liver hilus; distal pancreatectomy; emergency health service; small intestine resection; calculation; mediastinum lymph node; clinical outcome; omentectomy; albumin blood level; large intestine; low risk patient; primary debulking surgery; human; female; priority journal; article; cytoreductive outcomes; resectability score; triage algorithm
Journal Title:	Gynecologic Oncology
Volume:	158
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2020-09-01
Start Page:	608
End Page:	613
Language:	English
DOI:	10.1016/j.ygyno.2020.05.041
PUBMED:	32518012
PROVIDER:	scopus
PMCID:	PMC7487016
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85085956275&doi=10.1016%2fj.ygyno.2020.05.041&partnerID=40&md5=8e911189800c2bb746a441fc7e50e999
Notes:	Article -- Export Date: 1 October 2020 -- Source: Scopus