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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2021

01-08-2021 | Ovarian Cancer | Gynecologic Oncology

Multidisciplinary Surgical Approach to Increase Complete Cytoreduction Rates for Advanced Ovarian Cancer in a Tertiary Gynecologic Oncology Center

Authors: Karen M. Mulligan, MA Genetics, MD, Kate Glennon, MD, MRCPI, Fionán Donohoe, MD, MRCPI, MRCOG, Yvonne O’Brien, MD, MRCPI, MRCOG, Brian C. Mc Donnell, MD, Helena C. Bartels, MD, MRCPI, Carolien Vermeulen, MB, BCh, Tom Walsh, MD, MRCPI, MRCOG, Conor Shields, BSc, MD, FRCSI, Orla McCormack, MD, FRCSI, John Conneely, MD, BSc, MCh, FRCSI (Gen), William D. Boyd, MD, MRCOG, FRC, ONC, CAN, Ruaidhrí Mc Vey, LRCP&SI (Hons), MRCSI, MRCPI, MRCOG, MD, MCE, MSc, Jurgen Mulsow, MB, MD, FRCSI, Donal J. Brennan, MD, MRCPI, MRCOG, PhD

Published in: Annals of Surgical Oncology | Issue 8/2021

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Abstract

Background

Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit.

Methods

The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A).

Results

This study included 146 patients in cohort A (2006–2015) and 93 patients in cohort B (2017–2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006–2019).

Conclusions

The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
Appendix
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Metadata
Title
Multidisciplinary Surgical Approach to Increase Complete Cytoreduction Rates for Advanced Ovarian Cancer in a Tertiary Gynecologic Oncology Center
Authors
Karen M. Mulligan, MA Genetics, MD
Kate Glennon, MD, MRCPI
Fionán Donohoe, MD, MRCPI, MRCOG
Yvonne O’Brien, MD, MRCPI, MRCOG
Brian C. Mc Donnell, MD
Helena C. Bartels, MD, MRCPI
Carolien Vermeulen, MB, BCh
Tom Walsh, MD, MRCPI, MRCOG
Conor Shields, BSc, MD, FRCSI
Orla McCormack, MD, FRCSI
John Conneely, MD, BSc, MCh, FRCSI (Gen)
William D. Boyd, MD, MRCOG, FRC, ONC, CAN
Ruaidhrí Mc Vey, LRCP&SI (Hons), MRCSI, MRCPI, MRCOG, MD, MCE, MSc
Jurgen Mulsow, MB, MD, FRCSI
Donal J. Brennan, MD, MRCPI, MRCOG, PhD
Publication date
01-08-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09494-3

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