The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients.

2020 ◽  
Author(s):  
Shuang Ye ◽  
Yiyong Wang ◽  
Lei Chen ◽  
Xiaohua Wu ◽  
Huijuan Yang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Bowel Resection ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Anastomosis Group ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Debulking Surgery ◽  
Resection And Anastomosis

Abstract Background: To review the utilization and perioperative outcomes of bowel resection during cytoreduction of ovarian cancer patients in our institution. Methods: All the patients who received bowel resection including anastomosis and ostomy formation between 2006/01 and 2018/12 were identified. Clinicopathological information was abstracted from the medical records. Postoperative morbidities were assessed according to Clavien-Dindo classification (CDC).Results: There were 182 patients in the anastomosis group and 100 patients in the ostomy group, leading to a total of 282 patients. The median age was 57 years and most patients had high-grade serous histology (88.7%). 49 (17.3%) patients received neoadjuvant chemotherapy. During operation, 78.7% patients had ascites and the median volume was 800 mL. Extensive bowel resection (at least two-segment) and upper abdominal operation was performed in 29 (10.2%) and 69 (24.4%) patients, respectively. Rectosigmoid colon was the most commonly resected (83.8%), followed by right hemicolectomy (5.9%) and small bowel resection (2.8%). No macroscopic residual disease was observed in 42.9% of the patients, while 87.9% of had residual disease ≤1 cm. For the entire cohort, 19.9% (56/282) experienced different complications, not including anastomotic leak (AL). Severe complications (CDC 3-5) accounted for 7.8%, mostly pleural effusion requiring drainage (3.5%), and followed by wound dehiscence requiring delayed repair in operation room (1.8%). Nine patients experienced AL: one in the ostomy group with extensive bowel resection and eight in the anastomosis group. The overall AL rate was 4.2% (9/212) per anastomosis. The AL rate per anastomosis was quite comparable in different populations: 4.4% (patients in the anastomosis group), 4.3% (patients with one-segment bowel resection and anastomosis), 4.0% (patients with extensive bowel resection and anastomosis) and 5.0% (patients with isolated rectosigmoid resection and anastomosis).Conclusions: Execution of bowel resection as part of debulking surgery of patients with newly diagnosed ovarian cancer resulted in an acceptable morbidity rate.

The evaluation of intra- and postoperative complications related to debulking surgery with bowel resection in patients with FIGO stage III–IV ovarian cancer

2007 ◽  
Vol 17 (5) ◽  
pp. 993-997 ◽  
Author(s):  
M. Bidzinski ◽  
P. Derlatka ◽  
P. Kubik ◽  
I. Ziolkowska-Seta ◽  
A. Dańska-Bidzinska ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Bowel Resection ◽  
Intestinal Resection ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Hartmann’S Procedure ◽  
Debulking Surgery ◽  
Hartmann's Procedure

The surgical treatment of advanced ovarian cancer is based on the maximal debulking with widening the operation range to the infiltrated organs. The aims are as follows: (1) the assessment of the quantity and quality of intra- and postoperative complications in patients with advanced ovarian cancer in which partial bowel resection was performed and (2) the evaluation of intra- and postoperative complications related to surgery with bowel resection and anastomosis, compared to Hartmann's procedure. The analysis of debulking procedures with intestinal resection and postoperative period in 39 ovarian cancer patients, FIGO stage III–IV, was performed. During 39 operations, the most frequent type of resection was the sigmoidectomy or proctosigmoidectomy (29 patients). In the remaining patients, left- and right-side hemicolectomy or partial enterectomy was done. Twenty-four anastomosis and 15 Hartmann's procedures were performed. There were no differences between surgery with anastomosis and Hartmann's procedure in aspect of quantity of complications, blood loss, and the time of surgery. There were no statistically significant differences in overall survival and progression-free survival in both groups. We conclude that the percentage of complications related to debulking surgery with intestinal resection in advanced ovarian cancer patients might be accepted. The quantity of complications related to surgery with anastomosis and to Hartmann's procedure is similar. If possible, the surgery with anastomosis should be performed.

scholarly journals Choosing the right timing for interval debulking surgery and perioperative chemotherapy may improve the prognosis of advanced epithelial ovarian cancer: a retrospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dengfeng Wang ◽  
Guonan Zhang ◽  
Chunrong Peng ◽  
Yu Shi ◽  
Xunwei Shi
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Cancer Patients ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Postoperative Chemotherapy ◽  
Debulking Surgery ◽  
Interval Debulking Surgery

Abstract Background Primary debulking surgery (PDS) is the main treatment for patients with advanced ovarian cancer, and neoadjuvant chemotherapy (NACT) is for bulky stage III-IV patients who are poor surgical candidates and/or for whom there is a low likelihood of optimal cytoreduction. NACT can increase the rate of complete cytoreduction, but this advantage has not translated to an improvement in survival. Therefore, we aimed to identify factors associated with the survival of patients who received NACT followed by interval debulking surgery (IDS). Methods A retrospective study was conducted in FIGO stage IIIC-IV epithelial ovarian cancer patients who underwent PDS or IDS in our center between January 1st, 2013, and December 31st, 2018. Results A total of 273 cases were included, of whom 20 were lost to follow-up. Progression-free survival (PFS) and overall survival (OS) of the IDS and PDS groups were found to be similar, although the proportion of patients in stage IV and serum carbohydrate antigen 125 (CA125) levels before treatment in the IDS group were significantly higher than that in the PDS group. Body mass index (BMI), CA125 level before IDS, residual disease after surgery, and the interval between preoperative and postoperative chemotherapy were all found to be independent prognostic factors for PFS; FIGO stage, residual disease after surgery, and CA125 level before IDS were independent prognostic factors for OS. We found that PFS and OS were both significantly longer in patients with normal CA125 levels before IDS and when the interval between preoperative and postoperative chemotherapy was < 35.5 days (IDS-3 group) than for patients in the PDS group. Conclusions The results suggested the importance of timely IDS and postoperative chemotherapy and potentially allowed the identification of patients who would benefit the most from NACT. Normal CA125 levels before IDS and an interval between preoperative and postoperative chemotherapy no longer than 5 weeks were associated with improved prognosis in advanced ovarian cancer patients.

Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer following upfront radical debulking surgery

2016 ◽  
Vol 141 (2) ◽  
pp. 264-270 ◽  
Author(s):  
Florian Heitz ◽  
Philipp Harter ◽  
Piero F. Alesina ◽  
Martin K. Walz ◽  
Dietmar Lorenz ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Debulking Surgery ◽  
Postoperative Residual

scholarly journals SOX2 is a promising predictor of relapse and death in advanced stage high-grade serous ovarian cancer patients with residual disease after debulking surgery

2020 ◽  
Vol 7 (6) ◽  
pp. 1805094
Author(s):  
Maria Bååth ◽  
Sofia Westbom-Fremer ◽  
Laura Martin de la Fuente ◽  
Anna Ebbesson ◽  
Juliette Davis ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Residual Disease ◽  
High Grade ◽  
Advanced Stage ◽  
Serous Ovarian Cancer ◽  
Debulking Surgery

scholarly journals Survey on the current gynaecological approach of ovarian cancer patients: The utility of HIPEC

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Christos Iavazzo ◽  
Alexandros Fotiou ◽  
M. Tsiatas ◽  
Athina Christopoulou ◽  
John Spiliotis ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Cancer Recurrence ◽  
Advanced Ovarian Cancer ◽  
Self Report ◽  
Debulking Surgery ◽  
Current Management ◽  
Medical Oncologists ◽  
Interval Debulking Surgery

AbstractBackgroundThe aim of this survey was to acquire an overview of the current management of ovarian cancer with an emphasis on the utility of hyperthermic intraperitoneal chemotherapy (HIPEC).Methods: An email was sent to Oncologists prior to PSOGI International Symposium on Advanced Ovarian Cancer, Athens 11–13 April 2019. Doctors submitted responses on the relevant website. The self-report survey contained 17 questions.ResultsIn total, 467 Medical Oncologists, Surgical Oncologists or Gynaecologic Oncologists were participated and answered to this survey. The resectability of disease was evaluated by laparoscopy from 48.5% of the participants, while 51.5% answered that they stage their patients pre-surgically with the use of CT or MRI. The preferred first intervention in advanced ovarian cancer patients is the neoadjuvant chemotherapy followed by interval cytoreductive surgery (72%). Regarding the use of HIPEC, almost half of the participants answered that there is role of HIPEC use in ovarian cancer patients undergoing interval debulking surgery, while almost 70% answered positively about the utility of HIPEC use in ovarian cancer recurrence. As for the role of lymphadenectomy in advanced ovarian cancer patients, half of the responders answered negatively. Finally, only 25% of the participants responded that they always check the BRCA status of their ovarian cancer patients, despite the possible differentiation of treatment based on the molecular profiling (80%).ConclusionsThe results of this survey indicate the utility of HIPEC in treatment of ovarian cancer patients and the differences in the overall management of ovarian cancer patients in the current clinical practice.

Efficacy of dose-dense chemotherapy as first-line treatment of advanced ovarian cancer patients after non-optimal debulking.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18066-e18066
Author(s):  
Alexey Rumyantsev ◽  
Alexandra Tyulyandina ◽  
Ilya Pokataev ◽  
Konstantin Morkhov ◽  
Valentina Mikhailovna Nechuskina ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Advanced Ovarian Cancer ◽  
Residual Tumor ◽  
Severe Neutropenia ◽  
Front Line ◽  
Debulking Surgery ◽  
Dose Dense ◽  
Optimal Debulking

e18066 Background: Patients with advanced ovarian cancer have unfavorable prognosis after primary debulking surgery if the size of residual tumor exceeds 1 cm. The optimal approaches to systemic treatment of these patients remain unknown. We evaluated the efficacy and safety of dose-dose chemotherapy in frontline treatment of ovarian cancer patients after upfront non-optimal debulking surgery. Methods: This was a non-randomized single-arm phase II trial. We enrolled patients with advanced (FIGO III-IV) epithelial ovarian who underwent non-optimal upfront debulking surgery with residual tumor size > 10 mm. All patients were treated with dose-dense chemotherapy (ie, paclitaxel 80 mg/m2 day 1, 8, 15 + carboplatin AUC6 day 1, cycled every 21 days – 6 cycles). Patients in historical control arm received standard chemotherapy with paclitaxel 175 mg/m2 day 1 + carboplatin AUC6 day 1, cycled every 21 days – 6 cycles. No patient in experimental or control arm received front-line bevacizumab or PARP inhibitors. The primary endpoint of the trial was progression-free survival (PFS). According to the historical data of our department, 1-year PFS in this category of patients equals to 51%. To increase 1-year PFS to 70%, 40 patients should be enrolled with α = 0.05 and β = 0.20 and estimated data loss for 10% of patients. Results: The study enrolled 40 patients to dose-dense chemotherapy arm, control arm included 86 patients. The trial arms were balanced in terms of age, performance status and other characteristics. Median follow-up was 28.8 months. The 1-year PFS was 76.9% compared to 51% in historical arm, median PFS was 19.8 months and 12 months respectively (HR 0.61; 95% CI 0.39-0.95; p = 0,03). The 1-year overall survival rate was 92.3% with median OS not reached with specified follow-up period. Severe neutropenia, anemia, thrombocytopenia was observed in 82.1%, 53.8%, 15.3% of patients, respectively. Conclusions: The results of the study showed high efficacy of dose-dose chemotherapy as front line of treatment for advanced ovarian cancer patients after non-optimal upfront debulking surgery but one should consider high toxicity of this regimen.

scholarly journals Role of Lymphadenectomy During Interval Debulking Surgery Performed After Neoadjuvant Chemotherapy in Patients With Advanced Ovarian Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Minjun He ◽  
Yuerong Lai ◽  
Hongyu Peng ◽  
Chongjie Tong
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Progression Free Survival ◽  
Debulking Surgery ◽  
Hazard Ratios ◽  
Significant Difference ◽  
Interval Debulking Surgery

ObjectiveThe role of lymphadenectomy in interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer remains unclear. We aimed to investigate the clinical significance of lymphadenectomy in IDS.MethodsWe retrospectively reviewed and analyzed the data of patients with advanced ovarian cancer who underwent NACT followed by IDS.ResultsIn 303 patients receiving NACT-IDS, lymphadenectomy was performed in 127 (41.9%) patients. One hundred and sixty-three (53.8%) patients achieved no gross residual disease (NGRD), and 69 (22.8%) had residual disease &lt; 1 cm, whereas 71 (23.4%) had residual disease ≥ 1cm. No significant difference in progression-free survival (PFS) and overall survival (OS) was observed between the lymphadenectomy group and the no lymphadenectomy group in patients with NGRD, residual disease &lt; 1 cm, and residual disease ≥ 1 cm, respectively. The proportions of pelvic, para-aortic and distant lymph node recurrence were 7.9% (10/127), 4.7% (6/127) and 5.5% (7/127) in the lymphadenectomy group, compared with 5.7% (10/176, P = 0.448), 4.5% (8/176, P = 0.942) and 5.1% (9/176, P = 0.878), respectively, in no lymphadenectomy group. Multivariate analysis identified residual disease ≥ 1 cm [hazard ratios (HR), 4.094; P = 0.008] and elevated CA125 levels after 3 cycles of adjuvant chemotherapy (HR, 2.883; P = 0.004) were negative predictors for OS.ConclusionLymphadenectomy may have no therapeutic value in patients with advanced ovarian cancer underwent NACT-IDS. Our findings may help to better the therapeutic strategy for advanced ovarian cancer. More clinical trials are warranted to further clarify the real role of lymphadenectomy in IDS.

Primary Surgery or Neoadjuvant Chemotherapy in Advanced Ovarian Cancer: The Debate Continues…

2016 ◽  
pp. 153-162 ◽  
Author(s):  
Renee Cowan ◽  
Dennis Chi ◽  
Sean Kehoe ◽  
Matthew Nankivell ◽  
Alexandra Leary
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Tumor Biology ◽  
Advanced Ovarian Cancer ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Platinum Based Chemotherapy ◽  
Patient Reported ◽  
The Impact

Primary debulking surgery (PDS) followed by platinum-based chemotherapy has been the cornerstone of treatment for advanced ovarian cancer for decades. Primary debulking surgery has been repeatedly identified as one of the key factors in improving survival in patients with advanced ovarian cancer, especially when minimal or no residual disease is left behind. Achieving these results sometimes requires extensive abdominal and pelvic surgical procedures and consultation with other surgical teams. Some clinicians who propose a primary chemotherapy approach reported an increased likelihood of leaving no macroscopic disease after surgery and improved patient-reported outcomes and quality-of-life (QOL) measures. Given the ongoing debate regarding the relative benefit of PDS versus neoadjuvant chemotherapy (NACT), tumor biology may aid in patient selection for each approach. Neoadjuvant chemotherapy offers the opportunity for in vivo chemosensitivity testing. Studies are needed to determine the best way to evaluate the impact of NACT in each individual patient with advanced ovarian cancer. Indeed, the biggest utility of NACT may be in research, where this approach provides the opportunity for the investigation of predictive markers, mechanisms of resistance, and a forum to test novel therapies.

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