The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer Journal Article


Authors: Eisenhauer, E. L.; Abu-Rustum, N. R.; Sonoda, Y.; Levine, D. A.; Poynor, E. A.; Aghajanian, C.; Jarnagin, W. R.; DeMatteo, R. P.; D'Angelica, M. I.; Barakat, R. R.; Chi, D. S.
Article Title: The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer
Abstract: Objectives: To determine the survival impact of adding extensive upper abdominal surgical cytoreduction to standard surgical techniques for advanced ovarian cancer. Methods: The records of all patients with stages IIIC-IV epithelial ovarian cancer who underwent primary surgery at our institution from 1998 to 2003 were reviewed. The cohort was divided into 3 groups. Group 1 patients required extensive upper abdominal surgery, such as diaphragm peritonectomy/resection, resection of parenchymal liver or porta hepatis disease and/or splenectomy with or without distal pancreatectomy, to achieve optimal cytoreduction (residual disease ≤ 1 cm). Group 2 patients were optimally cytoreduced by standard surgical techniques, including hysterectomy, oophorectomy, omentectomy, and bowel resection. Group 3 patients were suboptimally cytoreduced. Primary outcome measures were response to primary chemotherapy, progression-free survival, and overall survival. Results: The cohort of 262 patients was divided as follows: Group 1, 57 patients; Group 2, 122 patients; and Group 3, 83 patients. The median follow-up was 36 months (range, 1-94 months). Frequency of clinical complete response in Groups 1, 2, and 3 was 82%, 78%, and 57%, respectively. The median progression-free survival for Groups 1, 2, and 3 was 24, 23, and 11 months, respectively. Progression-free survival for Groups 1 and 2 were equivalent (P = 0.53) and were significantly longer than for Group 3 (P < 0.001). The median overall survival was 84 and 38 months for Groups 2 and 3, respectively, and had not been reached for Group 1 by 68 months. Patients in Group 1 had equivalent overall survival to patients in Group 2 (P = 0.74) and improved survival over patients in Group 3 (P < 0.001). Prognostic factors significant on multivariate analysis included stage, optimal status, and ascites. Conclusions: Patients requiring extensive upper abdominal procedures to achieve optimal cytoreduction demonstrated a similar initial response, progression-free survival, and overall survival to patients optimally cytoreduced by standard surgical techniques. The presence of bulky upper abdominal disease alone did not appear to indicate poor tumor biology. This initial maximal surgical effort was associated with improved survival in patients who would have otherwise been suboptimally cytoreduced. © 2006 Elsevier Inc. All rights reserved.
Keywords: survival; adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; surgical technique; major clinical study; splenectomy; ascites; cancer growth; pancreas resection; cancer staging; outcome assessment; follow up; hysterectomy; neoplasm staging; pancreas; ovarian cancer; cytoreductive surgery; ovarian neoplasms; ovary cancer; spleen; ovariectomy; cohort analysis; liver; liver resection; new york city; intestine resection; gynecologic surgical procedures; multivariate analysis; cytoreduction; abdominal surgery; liver hilus; databases, factual; diaphragm; neoplasms, glandular and epithelial; peritoneum; pelvic exenteration; upper abdominal
Journal Title: Gynecologic Oncology
Volume: 103
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2006-12-01
Start Page: 1083
End Page: 1090
Language: English
DOI: 10.1016/j.ygyno.2006.06.028
PUBMED: 16890277
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 108" - "Export Date: 4 June 2012" - "CODEN: GYNOA" - "Source: Scopus"
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MSK Authors
  1. Richard R Barakat
    629 Barakat
  2. Dennis S Chi
    521 Chi
  3. Ronald P DeMatteo
    625 DeMatteo
  4. Yukio Sonoda
    306 Sonoda
  5. Elizabeth Poynor
    32 Poynor
  6. Douglas A Levine
    360 Levine
  7. William R Jarnagin
    621 Jarnagin