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Value of Tertiary Cytoreductive Surgery in Epithelial Ovarian Cancer: An International Multicenter Evaluation

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

Abstract

Background

The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival.

Methods

Retrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia.

Results

We evaluated 406 patients (median age, 55 years; range, 16–80 years). Median time from first to second recurrence was 18 months (2–204 months). Median follow-up from TCS was 14 months (0–182 months), and median OS was 26 months (95 % CI, 19.62–32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5–56.4 months) versus 12 months (95 % CI 9.3–14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS.

Conclusions

In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC.

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References

  1. 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 

  2. Chi DS, Bristow RE, Armstrong DK, Karlan BY. Is the easier way ever the better way? J Clin Oncol. 2011;29:4073–5.

    Article  PubMed  CAS  Google Scholar 

  3. Bristow RE. Surgical standards in the management of ovarian cancer. Curr Opin Oncol. 2000;12:474–80.

    Article  PubMed  CAS  Google Scholar 

  4. 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 

  5. du Bois A, Quinn M, Thigpen T, Vermorken J, Avall-Lundqvist E, Bookman M, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol. 2005;16:viii7–viii12,2005.

    Google Scholar 

  6. Chi DS, Franklin CC, Levine DA, Akselrod F, Sabbatini P, Jarnagin WR, et al. Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach. Gynecol Oncol. 2004;94:650–4.

    Article  PubMed  Google Scholar 

  7. Chi DS, McCaughty K, Diaz JP, Huh J, Schwabenbauer S, Hummer AJ, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer. 2006;106:1933–9.

    Article  PubMed  Google Scholar 

  8. Schorge JO, Wingo SN, Bhore R, Heffernan TP, Lea JS. Secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer. Int J Gynaecol Obstet. 2010;108:123–7.

    Article  PubMed  Google Scholar 

  9. Fanfani F, Fagotti A, Gallotta V, Ercoli A, Pacelli F, Costantini B, et al. Upper abdominal surgery in advanced and recurrent ovarian cancer: role of diaphragmatic surgery. Gynecol Oncol. 2010;116:497–501.

    Article  PubMed  Google Scholar 

  10. Park JY, Eom JM, Kim DY, Kim JH, Kim YM, Kim YT, et al. Secondary cytoreductive surgery in the management of platinum-sensitive recurrent epithelial ovarian cancer. J Surg Oncol. 2010;101:418–24.

    Article  PubMed  Google Scholar 

  11. Harter P, Hahmann M, Lueck HJ, Poelcher M, Wimberger P, Ortmann O, et al. Surgery for recurrent ovarian cancer: role of peritoneal carcinomatosis: exploratory analysis of the DESKTOP I Trial about risk factors, surgical implications, and prognostic value of peritoneal carcinomatosis. Ann Surg Oncol. 2009;16:1324–30.

    Article  PubMed  CAS  Google Scholar 

  12. Boran N, Hizli D, Yilmaz S, Turan T, Celik B, Karabuk E, et al. Secondary cytoreductive surgery outcomes of selected patients with paclitaxel/platinum sensitive recurrent epithelial ovarian cancer. J Surg Oncol. 2012;106:369–75.

    Article  PubMed  Google Scholar 

  13. Leitao Jr MM, Kardos S, Barakat RR, Chi DS. Tertiary cytoreduction in patients with recurrent ovarian carcinoma. Gynecol Oncol. 2004;95:181–8.

    Article  PubMed  Google Scholar 

  14. Karam AK, Santillan A, Bristow RE, Giuntoli R 2nd, Gardner GJ, Cass I, et al. Tertiary cytoreductive surgery in recurrent ovarian cancer: selection criteria and survival outcome. Gynecol Oncol. 2007;104:377–80.

    Article  PubMed  Google Scholar 

  15. Gultekin M, Velipaşaoğlu M, Aksan G, Dursun P, Dogan NU, Yuce K, et al. A third evaluation of tertiary cytoreduction. J Surg Oncol. 2008;98:530–4.

    Article  PubMed  Google Scholar 

  16. Shih KK, Chi DS, Barakat RR, Leitao Jr MM. Tertiary cytoreduction in patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer: an updated series. Gynecol Oncol. 2010;117:330–5.

    Article  PubMed  CAS  Google Scholar 

  17. Hızlı D, Boran N, Yılmaz S, Turan T, Altınbaş SK, Celik B, et al. Best predictors of survival outcome after tertiary cytoreduction in patients with recurrent platinum-sensitive epithelial ovarian cancer. Eur J Obstet Gynecol Reprod Biol. 2012;163:71–5.

    Article  PubMed  Google Scholar 

  18. Fotopoulou C, Richter R, Braicu IE, Schmidt SC, Neuhaus P, Lichtenegger W, et al. Clinical outcome of tertiary surgical cytoreduction in patients with recurrent epithelial ovarian cancer. Ann Surg Oncol. 2011;18:49–57.

    Article  PubMed  Google Scholar 

  19. International Federation of Gynecology and Obstetrics. Changing in definitions of clinical staging for carcinoma of the cervix and ovary. Am J Obstet Gynecol. 1987;156:263–4.

    Google Scholar 

  20. Harter P, du Bois A, Hahmann M, Hasenburg A, Burges A, Loibl S, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13:1702–10.

    Article  PubMed  Google Scholar 

  21. Braicu EI, Sehouli J, Richter R, Pietzner K, Denkert C, Fotopoulou C. Role of histological type on surgical outcome and survival following radical primary tumour debulking of epithelial ovarian, fallopian tube and peritoneal cancers. Br J Cancer. 2011;105:1818–24.

    Article  PubMed  Google Scholar 

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Acknowledgment

We would like kindly acknowledge following colleagues who contributed in collecting the eligible patients: Ziting Li, Huaying Wang and Xiaohua Wu from the Fudan University Cancer Hospital in Shanghai, as well as Faruk Kose and Taner Turan from the Etlik Zubeyde Hanım Maternity Hospital, Ankara, Turkey, T. Gungor and N.U. Dogan from the Zekai Tahir Burak Maternity Hospital, Ankara, Turkey, and Sara Boveri from European Institute of Oncology, Milan, Italy.

Conflict of Interest

None to declare.

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Authors and Affiliations

  1. Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany

    Christina Fotopoulou MD, PhD, Rolf Richter PhD, Ioana Braicu MD & Jalid Sehouli MD, PhD

  2. Department of Gynecologic Oncology, Fudan University Cancer Hospital, Shanghai, China

    Rongyu Zang MD, PhD & Dongli Liu MD

  3. Cancer Control Department, Zekai Tahir Burak Women’s Health and Research Hospital and Turkish Ministry of Health, Ankara, Turkey

    Murat Gultekin MD

  4. Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Gynecologic Oncology Center, Charles University in Prague and General University Hospital, Prague, Czech Republic

    David Cibula MD, PhD

  5. Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey

    Ali Ayhan MD, PhD

  6. Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Sven Mahner MD, PhD & Fabian Trillsch MD

  7. Departments of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany

    Philipp Harter MD

  8. Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA

    Sanjeev Kumar MD & Sean C. Dowdy MD, FACS

  9. Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy

    Michele Peiretti MD, PhD & Angelo Maggioni MD

  10. Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway

    Claes Trope MD, PhD

  11. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Claes Trope MD, PhD

Authors
  1. Christina Fotopoulou MD, PhD
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  2. Rongyu Zang MD, PhD
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  3. Murat Gultekin MD
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  4. David Cibula MD, PhD
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  5. Ali Ayhan MD, PhD
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  6. Dongli Liu MD
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  7. Rolf Richter PhD
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  8. Ioana Braicu MD
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  9. Sven Mahner MD, PhD
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  10. Philipp Harter MD
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  11. Fabian Trillsch MD
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  12. Sanjeev Kumar MD
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  13. Michele Peiretti MD, PhD
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  14. Sean C. Dowdy MD, FACS
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  15. Angelo Maggioni MD
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  16. Claes Trope MD, PhD
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  17. Jalid Sehouli MD, PhD
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Corresponding author

Correspondence to Christina Fotopoulou MD, PhD.

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Fotopoulou, C., Zang, R., Gultekin, M. et al. Value of Tertiary Cytoreductive Surgery in Epithelial Ovarian Cancer: An International Multicenter Evaluation. Ann Surg Oncol 20, 1348–1354 (2013). https://doi.org/10.1245/s10434-012-2673-z

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  • DOI: https://doi.org/10.1245/s10434-012-2673-z

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