Skip to main content

Advertisement

SpringerLink
Log in

Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To analyze the impact of radical cytoreductive surgery—as part of primary tumor debulking—on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery.

Methods

Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC–IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected.

Results

Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients. Advanced age (hazard ratio [HR] 1.04, 95 % confidence interval [CI] 1.02–1.06, P < 0.01), FIGO stage IV disease (HR 3.61, 95 % CI 1.48–8.83, P < 0.01), and grossly visible RD (HR 3.24, 95 % CI 1.90–5.53, P < 0.01) were identified as significant factors associated with poor prognosis in the entire cohort of 203 patients. Radical surgery (HR 0.56, 95 % CI 0.37–0.87, P = 0.01) was associated with improved survival. In the subgroup of patients with stage IIIC disease with peritoneal carcinomatosis, independent prognostic factors were advanced age (HR 1.04, 95 % CI 1.01–1.06, P = 0.01), radical surgery (HR 0.58, 95 % CI 0.35–0.96, P = 0.03), and grossly visible RD (HR 2.86, 95 % CI 1.55–5.30, P < 0.01). Patients with no gross RD had the longest overall survival (86 months) compared with RD 0.1–1 cm (46 months) and RD >1.0 cm (37 months) (P < 0.01).

Conclusions

No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Shih KK, Chi DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol. 2010;21:75–80.

    Article  PubMed  Google Scholar 

  3. Hoskins WJ, McGuire WP, Brady MF, et al. 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.

    PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Bristow RE, del Carmen MG, Kaufman HS, Montz FJ. Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg. 2003;197:565–74.

    Article  PubMed  Google Scholar 

  6. Park JY, Seo SS, Kang S, Lee KB, Lim SY, Choi HS, Park SY. The benefits of low anterior en bloc resection as part of cytoreductive surgery for advanced primary and recurrent epithelial ovarian cancer patients outweigh morbidity concerns. Gynecol Oncol. 2006;103:977–84.

    Article  PubMed  Google Scholar 

  7. Aletti GD, Podratz KC, Jones MB, Cliby WA. Role of rectosigmoidectomy and stripping of pelvic peritoneum in outcomes of patients with advanced ovarian cancer. J Am Coll Surg. 2006;203:521–6.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. Salani R, Zahurak ML, Santillan A, Giuntoli RL 2nd, Bristow RE. Survival impact of multiple bowel resections in patients undergoing primary cytoreductive surgery for advanced ovarian cancer: a case-control study. Gynecol Oncol. 2007;107:495–9.

    Article  PubMed  Google Scholar 

  10. Bristow RE, Peiretti M, Zanagnolo V, Salani R, Giuntoli RL 2nd, Maggioni A. Transverse colectomy in ovarian cancer surgical cytoreduction: operative technique and clinical outcome. Gynecol Oncol. 2008;109:364–9.

    Article  PubMed  Google Scholar 

  11. Chi DS, Eisenhauer EL, Zivanovic O, et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol. 2009;114:26–31.

    Article  PubMed  Google Scholar 

  12. Kommoss S, Rochon J, Harter P, et al. Prognostic impact of additional extended surgical procedures in advanced-stage primary ovarian cancer. Ann Surg Oncol. 2010;17:279–86.

    Article  PubMed  CAS  Google Scholar 

  13. Peiretti M, Zanagnolo V, Aletti GD, et al. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: surgical and oncological outcomes. Single institution experience. Gynecol Oncol. 2010;119:259–64.

    Google Scholar 

  14. Omura GA, Brady MF, Homesley HD, et al. Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience. J Clin Oncol. 1991;9:1138–50.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Winter WE 3rd, Maxwell GL, Tian C, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2007;25:3621–7.

    Article  PubMed  Google Scholar 

  19. Winter WE 3rd, Maxwell GL, Tian C, et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2008;26:83–9.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Wimberger P, Wehling M, Lehmann N, et al. Influence of residual tumor on outcome in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Ann Surg Oncol. 2010;17:1642–8.

    Article  PubMed  Google Scholar 

  22. Eisenkop SM, Spirtos NM. What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer? Gynecol Oncol. 2001;82:489–97.

    Article  PubMed  CAS  Google Scholar 

  23. Covens AL. A critique of surgical cytoreduction in advanced ovarian cancer. Gynecol Oncol. 2000;78:269–74.

    Article  PubMed  CAS  Google Scholar 

  24. Berman ML. Future directions in the surgical management of ovarian cancer. Gynecol Oncol. 2003;90:S33–9.

    Article  PubMed  Google Scholar 

  25. Crawford SC, Vasey PA, Paul J, Hay A, Davis JA, Kaye SB. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 trial. J Clin Oncol. 2005;23:8802–11.

    Article  PubMed  Google Scholar 

  26. Chang SJ, Bristow RE. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining “optimal” residual disease. Gynecol Oncol. 2012;125:483–92.

    Article  PubMed  Google Scholar 

  27. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975;42:101–4.

    PubMed  CAS  Google Scholar 

  28. Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 2011;(8):CD007565.

  29. Ang C, Chan KK, Bryant A, Naik R, Dickinson HO. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 2011;(4):CD007697.

Download references

Acknowledgment

R.E.B. was supported by the Queen of Hearts Foundation.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea

    Suk-Joon Chang MD, PhD & Hee-Sug Ryu MD, PhD

  2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA

    Robert E. Bristow MD, MBA

Authors
  1. Suk-Joon Chang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert E. Bristow MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hee-Sug Ryu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Suk-Joon Chang MD, PhD or Robert E. Bristow MD, MBA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, SJ., Bristow, R.E. & Ryu, HS. Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer. Ann Surg Oncol 19, 4059–4067 (2012). https://doi.org/10.1245/s10434-012-2446-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2446-8

Keywords

Search

Navigation