Video-assisted thoracic surgery in the primary management of advanced ovarian carcinoma with moderate to large pleural effusions: A Memorial Sloan Kettering Cancer Center Team Ovary Study Journal Article
| Authors: | Boerner, T.; Filippova, O. T.; Chi, A. J.; Iasonos, A.; Zhou, Q. C.; Long Roche, K.; Zivanovic, O.; Park, B. J.; Huang, J.; Jones, D. R.; Abu-Rustum, N. R.; Gardner, G.; Sonoda, Y.; Chi, D. S. |
| Article Title: | Video-assisted thoracic surgery in the primary management of advanced ovarian carcinoma with moderate to large pleural effusions: A Memorial Sloan Kettering Cancer Center Team Ovary Study |
| Abstract: | Objectives: We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. Methods: Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01–01/19. Differences between treatment groups were tested using standard statistical techniques. Results: One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8–51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5–87.8) vs. 37.4 months (95% CI: 33.3–45.2); p =.016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14–4.18; p =.019) and age ≥ 65 (HR 1.98, 95% CI: 1.16–3.40; p =.013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). Conclusions: VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions. © 2020 Elsevier Inc. |
| Keywords: | adult; aged; cancer surgery; major clinical study; overall survival; advanced cancer; adjuvant therapy; cancer patient; follow up; antineoplastic agent; cytoreductive surgery; peritoneum cancer; cohort analysis; retrospective study; cancer mortality; disease severity; minimal residual disease; ovary carcinoma; pleura effusion; neoadjuvant chemotherapy; ca 125 antigen; uterine tube carcinoma; decision making; video assisted thoracoscopic surgery; advanced ovarian carcinoma; pleural disease; serum albumin; pleura disease; clinical outcome; pleurodesis; pleural effusion; albumin blood level; talc; primary debulking surgery; long term survival; human; female; priority journal; article; median survival time; mortality risk; thoracic surgeon |
| Journal Title: | Gynecologic Oncology |
| Volume: | 159 |
| Issue: | 1 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-10-01 |
| Start Page: | 66 |
| End Page: | 71 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2020.07.101 |
| PUBMED: | 32792282 |
| PROVIDER: | scopus |
| PMCID: | PMC7541719 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 November 2020 -- Source: Scopus |
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