Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2010

01-01-2010 | Gynecologic Oncology

Prognostic Impact of Additional Extended Surgical Procedures in Advanced-Stage Primary Ovarian Cancer

Authors: S. Kommoss, MD, J. Rochon, P. Harter, MD, F. Heitz, MD, J. P. Grabowski, MD, N. Ewald-Riegler, MD, M. Haberstroh, MD, T. Neunhoeffer, MD, J. Barinoff, MD, R. Gomez, MD, A. Traut, A. du Bois, MD

Published in: Annals of Surgical Oncology | Issue 1/2010

Login to get access

Abstract

Background

Treatment of advanced-stage ovarian carcinoma includes radical cytoreductive surgery, which aims at removing all visible tumor tissue followed by platinum and paclitaxel chemotherapy. Complete tumor resection may require extended surgical procedures. This paper reports on the prognostic impact of extensive surgery and surgical morbidity in patients with advanced-stage ovarian carcinoma.

Methods

Patients with ovarian carcinoma [Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) stage IIIB–IV] undergoing primary surgery in our tertiary gynecologic oncology unit between 1997 and 2007 were eligible for this study. The impact of established prognostic factors and the interaction with extent of surgical procedures on survival were assessed.

Results

A total of 267 patients aged between 29 and 88 years (median 64 years) were eligible for this study. Overall survival time was improved in patients who underwent complete tumor resection [hazard ratio (HR) 3.61 (1.91–6.61), P < 0.001]. No significant survival difference was observed between completely operated patients in whom extended or standard surgical procedures were applied [HR 1.37 (0.70–2.69), P = 0.358], and severe surgical complications were found to be equally distributed between the two patient groups.

Conclusions

Our results may encourage the application of extended surgical procedures in patients who would otherwise be rendered incompletely debulked after primary cytoreduction. We could demonstrate an impact of complete tumor resection on patient prognosis and this was not traded off for extensive additional surgical morbidity.
Appendix
Available only for authorised users
Literature
1.
du Bois A, Quinn M, Thigpen T, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol. 2005;16(Suppl 8):viii7–viii12.
2.
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.CrossRefPubMed
3.
du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115:1234–44.CrossRefPubMed
4.
Montz FJ, Schlaerth JB, Berek JS. Resection of diaphragmatic peritoneum and muscle: role in cytoreductive surgery for ovarian cancer. Gynecol Oncol. 1989;35:338–40.CrossRefPubMed
5.
Chen LM, Leuchter RS, Lagasse LD, Karlan BY. Splenectomy and surgical cytoreduction for ovarian cancer. Gynecol Oncol. 2000;77:362–8.CrossRefPubMed
6.
Merideth MA, Cliby WA, Keeney GL, Lesnick TG, Nagorney DM, Podratz KC. Hepatic resection for metachronous metastases from ovarian carcinoma. Gynecol Oncol. 2003;89:16–21.CrossRefPubMed
7.
Eisenhauer EL, Abu-Rustum NR, Sonoda Y, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol. 2006;103:1083–90.CrossRefPubMed
8.
Kruskal WH, Wallis WAL. Use of ranks in one-criterion variance analysis. J Am Stat Assoc. 1952;47:583–621.CrossRef
9.
Armitage PBG. Statistical methods in medical research, 3rd ed. Oxford: Blackwell; 1994.
10.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRef
11.
Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–70.PubMed
12.
Cox DR. Regression models and life tables. J R Stat Soc B. 1972;34:187–202.
13.
Meigs J. Tumors of the female pelvic organs. New York: Macmillan; 1934.
14.
Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, Ball H, Berek JS. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol. 1994;170:974–9; discussion 979–80.PubMed
15.
Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998;69:103–8.CrossRefPubMed
16.
Bristow RE, Montz FJ, Lagasse LD, Leuchter RS, Karlan BY. Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol. 1999;72:278–87.CrossRefPubMed
17.
Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975;42:101–4.PubMed
18.
Piver MS, Baker T. The potential for optimal (less than or equal to 2 cm) cytoreductive surgery in advanced ovarian carcinoma at a tertiary medical center: a prospective study. Gynecol Oncol. 1986;24:1–8.CrossRefPubMed
19.
Aletti GD, Dowdy SC, Gostout BS, et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol. 2006;107:77–85.PubMed
20.
Chi DS, Eisenhauer EL, Lang J, et al. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol. 2006;103:559–64.CrossRefPubMed
21.
Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Aghajanian C, Barakat RR, Chi DS. The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecol Oncol. 2008;108:276–81.CrossRefPubMed
22.
Eisenkop SM, Spirtos NM. Procedures required to accomplish complete cytoreduction of ovarian cancer: is there a correlation with “biological aggressiveness” and survival? Gynecol Oncol. 2001;82:435–41.CrossRefPubMed
23.
Covens AL. A critique of surgical cytoreduction in advanced ovarian cancer. Gynecol Oncol. 2000;78:269–74.CrossRefPubMed
24.
Markman M. Concept of optimal surgical cytoreduction in advanced ovarian cancer: a brief critique and a call for action. J Clin Oncol. 2007;25:4168–70.CrossRefPubMed
25.
Hacker NF. Controversial aspects of cytoreductive surgery in epithelial ovarian cancer. Baillieres Clin Obstet Gynaecol. 1989;3:49–57.CrossRefPubMed
26.
Le T, Krepart GV, Lotocki RJ, Heywood MS. Does debulking surgery improve survival in biologically aggressive ovarian carcinoma? Gynecol Oncol. 1997;67:208–14.CrossRefPubMed
27.
Naik R, Nordin A, Cross PA, Hemming D, de Barros Lopes A, Monaghan JM. Complete cytoreduction: is epithelial ovarian cancer confined to the pelvis biologically different from bulky abdominal disease? Gynecol Oncol. 2000;78:176–80.CrossRefPubMed
28.
Spirtos NM, Gross GM, Freddo JL, Ballon SC. Cytoreductive surgery in advanced epithelial cancer of the ovary: the impact of aortic and pelvic lymphadenectomy. Gynecol Oncol. 1995;56:345–52.CrossRefPubMed
29.
Aletti GD, Podratz KC, Moriarty JP, Cliby WA, Long KH. Aggressive and complex surgery for advanced ovarian cancer: an economic analysis. Gynecol Oncol. 2009;112:16–21.CrossRefPubMed
Metadata
Title
Prognostic Impact of Additional Extended Surgical Procedures in Advanced-Stage Primary Ovarian Cancer
Authors
S. Kommoss, MD
J. Rochon
P. Harter, MD
F. Heitz, MD
J. P. Grabowski, MD
N. Ewald-Riegler, MD
M. Haberstroh, MD
T. Neunhoeffer, MD
J. Barinoff, MD
R. Gomez, MD
A. Traut
A. du Bois, MD
Publication date
01-01-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0787-8

Other articles of this Issue 1/2010

Annals of Surgical Oncology 1/2010 Go to the issue

Translational Research and Biomarkers

Thermal Sensitization Using Induced Oxidative Stress Decreases Tumor Growth in an In Vivo Model of Hyperthermic Intraperitoneal Perfusion

Colorectal Cancer

Searching for a Cutoff Value for Lymph Nodes Retrieved as a Quality Control of Surgery and Pathology in Colon Cancer

Bone and Soft Tissue Sarcomas

Perioperative Hyperfractionated High-Dose Rate Brachytherapy for the Treatment of Soft Tissue Sarcomas: Multicentric Experience

Breast Oncology

The Effects of Additional Tumor Cavity Sampling at the Time of Breast-Conserving Surgery on Final Margin Status, Volume of Resection, and Pathologist Workload

Breast Oncology

Nipple-Sparing Mastectomy: Overcoming Oncological Outcomes Challenges

Translational Research and Biomarkers

Association Analysis of Wnt Pathway Genes on Prostate-Specific Antigen Recurrence After Radical Prostatectomy