Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients

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.

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Systematic Pelvic and Aortic Lymphadenectomy in Advanced Ovarian Cancer Patients at the Time of Interval Debulking Surgery: A Double-Institution Case–Control Study

Annals of Surgical Oncology ◽

10.1245/s10434-012-2400-9 ◽

2012 ◽

Vol 19 (11) ◽

pp. 3522-3527 ◽

Cited By ~ 20

Author(s):

Anna Fagotti ◽

Pierandrea De Iaco ◽

Francesco Fanfani ◽

Giuseppe Vizzielli ◽

Federica Perelli ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Patients ◽

Case Control Study ◽

Advanced Ovarian Cancer ◽

Case Control ◽

Debulking Surgery ◽

Interval Debulking Surgery ◽

Control Study

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Clinical significance of primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery in advanced ovarian cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa015 ◽

2020 ◽

Vol 50 (4) ◽

pp. 379-386

Author(s):

Shin Nishio ◽

Kimio Ushijima

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Clinical Significance ◽

Performance Status ◽

Advanced Ovarian Cancer ◽

Stage Iii ◽

Current Evidence ◽

Debulking Surgery ◽

Primary Debulking Surgery ◽

Interval Debulking Surgery

Abstract Primary debulking surgery followed by platinum-based chemotherapy remains the standard treatment of patients with stage III–IV epithelial ovarian cancer. Neoadjuvant chemotherapy is an alternative treatment regimen that can be considered in selected patients. Complete cytoreduction, both through primary debulking surgery and interval debulking surgery, has a major positive effect on survival and should be the goal, even if this requires extensive surgery. When thorough assessment of tumor spread and performance status of the patient indicates that complete primary cytoreduction is not feasible without unacceptable morbidity, then alternative therapeutic strategies, such as neoadjuvant chemotherapy, must be considered. Such patients can be offered the option of interval debulking surgery after checking their response to neoadjuvant chemotherapy and resolution of the initial obstacles for primary debulking surgery (i.e. complete response of irresectable disease and improvement of the performance status). Current evidence suggests that a selected group of patients with International Federation of Gynecology and Obstetrics stage III–IV ovarian cancer will benefit from NAC-IDS. Research is ongoing to identify patients who might derive the greatest benefit from neoadjuvant chemotherapy followed by interval debulking surgery, instead of primary debulking surgery, on the basis of radiological, genetic, pathological, and immunological variables. In this review, we discuss current knowledge about the clinical significance of primary debulking surgery and neoadjuvant chemotherapy in advanced ovarian cancer and discuss unanswered questions in the field.

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Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery?

Gynecologic Oncology ◽

10.1016/j.ygyno.2009.09.015 ◽

2010 ◽

Vol 116 (1) ◽

pp. 72-77 ◽

Cited By ~ 40

Author(s):

A. Fagotti ◽

F. Fanfani ◽

G. Vizzielli ◽

V. Gallotta ◽

A. Ercoli ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Patients ◽

Advanced Ovarian Cancer ◽

Debulking Surgery ◽

Interval Debulking Surgery ◽

Work Up

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

Journal of Ovarian Research ◽

10.1186/s13048-021-00801-4 ◽

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.

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