Procedures Required to Accomplish Complete Cytoreduction of Ovarian Cancer: Is There a Correlation with “Biological Aggressiveness” and Survival?

2001 ◽  
Vol 82 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Scott M. Eisenkop ◽  
Nick M. Spirtos
Keyword(s):  
Ovarian Cancer ◽  
Complete Cytoreduction

scholarly journals An update on preoperative assessment of the resectability of advanced ovarian cancer

2019 ◽  
Vol 41 (3) ◽  
Author(s):  
Philippe Kadhel ◽  
Aurélie Revaux ◽  
Marie Carbonnel ◽  
Iptissem Naoura ◽  
Jennifer Asmar ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Preoperative Assessment ◽  
Complete Cytoreduction ◽  
Sufficient Information ◽  
Positron Emission ◽  
Composite Models ◽  
Improving Accuracy

AbstractThe best prognosis for advanced ovarian cancer is provided by no residual disease after primary cytoreductive surgery. It is thus important to be able to predict resectability that will result in complete cytoreduction, while avoiding unnecessary surgery that may leave residual disease. No single procedure appears to be sufficiently accurate and reliable to predict resectability. The process should include a preoperative workup based on clinical examination, biomarkers, especially tumor markers, and imaging, for which computed tomography, as well as sonography, magnetic resonance imaging and positron-emission tomography, can be used. This workup should provide sufficient information to determine whether complete cytoreduction is possible or if not, to propose neoadjuvant chemotherapy which is preferable in this case. For the remaining patients, laparoscopy is broadly recommended as an ultimate triage step. However, its modalities are still debated, and several scores have been proposed for standardization and improving accuracy. The risk of false negatives requires a final assessment of resectability as the first stage of cytoreductive surgery by laparotomy. Composite models, consisting of several criteria of workup and, sometimes, laparoscopy have been proposed to improve the accuracy of the predictive process. Regardless of the modality, the process appears to be accurate and reliable for predicting residual disease but less so for predicting complete cytoreduction and thus avoiding unnecessary surgery and an inappropriate treatment strategy. Overall, the proposed procedures are heterogeneous, sometimes unvalidated, or do not consider advances in surgery. Future techniques and/or models are still needed to improve the prediction of complete resectability.

scholarly journals The surgical treatment of thoracic metastases in ovarian cancer

2015 ◽  
Vol 10 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Alice SAVESCU ◽  
◽  
Irina BALESCU ◽  
Nicolae BACALBASA ◽  
◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Treatment ◽  
Literature Review ◽  
Surgical Procedures ◽  
Complete Cytoreduction ◽  
Advanced Stage ◽  
Lymphatic Route

Ovarian cancer still represents one of the most aggressive malignancies affecting women worldwide. Unfortunately many patients are still diagnosed in an advanced stage of the disease when distal metastases are already present. When it comes to thoracic involvement in advanced stage ovarian cancer, this may develop via peritoneal, hematogenous and lymphatic route. This is a literature review of the most commonly seen involvements in ovarian cancer and of the most appropriate surgical procedures which might be performed in order to increase the rate of complete cytoreduction.

Role of laparoscopy to evaluate candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer

2006 ◽  
Vol 16 (Suppl 1) ◽  
pp. 35-40 ◽  
Author(s):  
X. Deffieux ◽  
D. Castaigne ◽  
C. Pomel
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Carcinoma ◽  
Preoperative Evaluation ◽  
Residual Tumor ◽  
Complete Cytoreduction ◽  
Advanced Stages ◽  
Laparoscopic Evaluation ◽  
Cancer Laparoscopy

The objective of this study was to evaluate the role of laparoscopy in selecting candidates for complete cytoreduction surgery in epithelial ovarian carcinoma. We performed an explorative laparoscopy in 15 women presenting with advanced ovarian carcinoma, and for whom the preoperative evaluation was considered unsatisfactory, to define the possibility of achieving a complete cytoreduction. We focused on three sites of carcinomatosis: bowel, liver pedicle, and right diaphragmatic dome. Laparoscopic evaluation was successful in all 15 patients. Four patients were considered to have unresectable carcinomatosis because of extensive involvement of the small bowel and therefore had no laparotomy. These women underwent neoadjuvant chemotherapy in the following 2 weeks. Eleven patients were considered to have resectable peritoneal carcinomatosis (PC). Ten women had no macroscopic residual tumor after surgery. A modified posterior exenteration was performed in five patients. The laparoscopic exploration had underestimated the liver pedicle involvement in two patients, but only one had an infracentimetric residual tumor after surgery. Laparoscopy is a reliable method of exploring PC in advanced-stage ovarian cancer. Laparoscopy may obviate the need for unnecessary laparotomy in many cases and may, therefore, contribute to a better quality of life for patients found to have unresectable disease.

scholarly journals 30 Years of Experience in the Management of Stage III and IV Epithelial Ovarian Cancer: Impact of Surgical Strategies on Survival

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 768 ◽  
Author(s):  
Berenice Delga ◽  
Jean-Marc Classe ◽  
Gilles Houvenaeghel ◽  
Guillaume Blache ◽  
Laura Sabiani ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Complete Resection ◽  
Complete Cytoreduction ◽  
Surgical Strategy ◽  
Stage Iii ◽  
Resection Rate ◽  
Time Intervals ◽  
Surgical Strategies

Objective: to analyze the evolution of surgical techniques and strategies, and to determine their influence on the survival of patients with stage III or IV epithelial ovarian cancer (EOC). Methods: a retrospective data analysis was performed in two French tertiary cancer institutes. The analysis included clinical information, cytoreductive outcome (complete, optimal and suboptimal), definitive pathology, Overall Survival (OS), and Progression-Free Survival (PFS). Three surgical strategies were compared: Primary Cytoreductive Surgery (PCS), Interval Cytoreductive Surgery (ICS) after three cycles of Neo-Adjuvant Chemotherapy (NAC), and Final Cytoreductive Surgery (FCS) after at least six cycles of NAC. We analyzed four distinct time intervals: prior to 2000, between 2000 and 2004, between 2005 and 2009, and after 2009. Results: data from 1474 patients managed for International Federation of Gynecology and Obstetrics (FIGO) stages III (80%) or IV (20%) EOC were analyzed. Throughout the four time intervals, the rate of patients who were treated only medically increased significantly (10.1% vs. 22.6% p < 0.001). NAC treatment increased from 20.1% to 52.2% (p < 0.001). Complete resection rate increased from 37% to 66.2% (p < 0.001). Of our study population, 1260 patients (85.5%) underwent surgery. OS was longer in cases of complete cytoreduction (Hazard Ratio (HR) = 2.123 CI 95% [1.816–2.481] p < 0.001) but the surgical strategy itself did not affect median OS. OS was 44.9 months, 50.3 months, and 42 months for PCS, ICS, and FCS, respectively (p = 0.410). After adjusting for surgical strategies (PCS, ICS, and FCS), all patients with complete cytoreduction presented similar OS with no significant difference. However, PFS was three months shorter when FCS was compared to PCS (p < 0.001). Conclusion: In our 30 years’ experience of EOC management, complete resection rate was the only independent factor that significantly improved OS and PFS, regardless of the surgical strategy.

A multivariate analysis of the prognostic impact of tumor burden, surgical timing and complexity after complete cytoreduction for advanced ovarian cancer

2020 ◽  
Vol 158 (3) ◽  
pp. 614-621 ◽  
Author(s):  
Martina Aida Angeles ◽  
Agnieszka Rychlik ◽  
Bastien Cabarrou ◽  
Emanuela Spagnolo ◽  
Frédéric Guyon ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Multivariate Analysis ◽  
Advanced Ovarian Cancer ◽  
Tumor Burden ◽  
Complete Cytoreduction ◽  
Prognostic Impact ◽  
Surgical Timing
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