A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer

ObjectivesOvarian cancer patients with miliary disease have the lowest rates of complete surgical resection and poorest survival. Adjunct surgical techniques may potentially increase rates of complete surgical resection. No studies have evaluated the use of these techniques in primary debulking surgery for ovarian cancer patients with miliary disease. The aim of this study was to examine the use of adjunct surgical techniques during primary debulking surgery for patients with advanced epithelial ovarian, fallopian tube, and primary peritoneal cancer with miliary disease.MethodsMedical records of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IIIC–IVB epithelial ovarian, fallopian tube, or primary peritoneal cancer with miliary disease undergoing primary debulking surgery from January 2010 to December 2014 were reviewed. Adjunct surgical techniques were defined as ultrasonic surgical aspiration, argon enhanced electrocautery, thermal plasma energy, and traditional electrocautery ablation. Patients undergoing surgery with and without these devices were compared with respect to demographics, operative characteristics, postoperative complications, residual disease, progression free survival and overall survival.ResultsA total of 135 patients with miliary disease underwent primary debulking surgery, of which 30 (22.2%) patients used adjunct surgical techniques. The most common devices were ultrasonic surgical aspiration (40%) and argon enhanced electrocautery (36.7%). The most common sites of use were diaphragm (63.3%), pelvic peritoneum (30%), bowel mesentery (20%), and large bowel serosa (20%). There were no differences in age, stage, primary site, histology, operative time, surgical complexity, or postoperative complications for patients operated on with or without these devices. Volume of residual disease was similar (0.1–1 cm: 60% with adjunct techniques versus 68.6% without; complete surgical resection: 16.7% with adjunct techniques versus 13.3% without; p=0.67). For patients with ≤1 cm residual disease, median progression free survival (15 versus 15 months, p=0.65) and median overall survival (40 versus 55 months, p=0.38) were also similar.ConclusionAdjunct surgical techniques may be incorporated during primary debulking surgery for patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer with miliary disease; however, these do not improve the rate of optimal cytoreduction.

Download Full-text

Neoadjuvant chemotherapy versus primary debulking surgery in advanced ovarian cancer: Experience in Mexican population.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15567 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15567-e15567

Author(s):

Abdel Karim Dip Borunda ◽

Eucario Leon Rodriguez ◽

Alejandra Armengol Alonso

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Prospective Trial ◽

Advanced Ovarian Cancer ◽

Ca 125 ◽

Debulking Surgery ◽

Histologic Subtype ◽

Primary Debulking Surgery ◽

Survival Difference ◽

Significant Survival

e15567 Background: Primary debulking surgery is considered the standard of treatment in advanced ovarian cancer (AOC) while neoadjuvant chemotherapy is used in non resectable stages. Methods: We retrospectively analyzed 68 AOC cases from January 2000 to December 2011. 35 received neoadjuvant chemotherapy (NAC) while 33 were resected primarily and received adjuvant chemotherapy (AC). To compare both groups we used T standard test and 2 sided chi -squared. Non parametric variables were analyzed with U Mann – Whitney. Overall survival(OS) was analyzed using Kaplan Meier method with log rank test. We considered statistically significant p<0.05. (SPSS v 17). Results: The median age was 60 (NAC) vs 53(AC) years respectively. The NAC group had more advanced stage disease (FIGO IIIC/IV stage; 71/29% vs 91/9%; p=0.04). The most frequent histologic subtype in both groups was serous - papillary and histologic grade was poorly differentiated in 71 vs 72% (p=0.41). At diagnosis the median levels of ca-125 were 1,896 U/ml for NAC group vs 768 U/ml for AC group (p=0.025). After the primary treatment received the median levels of ca – 125 were 29 U/ml vs 84 U/ml (p=0.76). Platin based chemotherapy was used in 95% vs 70% respectively. Complete resection of macroscopic disease was observed in 68% of NAC vs 63% in AC respectively. No statistical differences were observed in surgical time (median 192 min vs 204 min; p=0.55) and surgical bleeding (468 vs 510ml; p=0.79). Median survival time was 23 +/-26 months for neoadjuvant and 27+/- 35 months for primary surgery (p=0.56). In a subgroup analysis of patients who received 6 neoadjuvant cycles vs perioperatory chemotherapy (3 pre and 3 postoperatory) we observed a significant survival difference, with a median of 62 months (95% CI 12-38) vs 12 months (95% CI 54 – 178) respectively (p=0.010). Conclusions: Non inferior survival or differences in surgical outcomes were observed with neoadjuvant therapy. Significant survival increase was observed in patients who received complete chemotherapy schedule before surgery, this evidence allowed to design a prospective trial in our Institution.

Download Full-text