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The impact of ultra-radical surgery in the management of patients with stage IIIC and IV epithelial ovarian, fallopian tube, and peritoneal cancer

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

The aim of this study is to estimate the percentage of patients with metastatic ovarian, fallopian tube, and primary peritoneal cancer requiring ultra-radical surgery to achieve cytoreduction to less than 1 cm (optimal) or no macroscopic residual disease (complete).

Methods

Perioperative data were collected prospectively on consecutive patients undergoing elective cytoreductive surgery for metastatic epithelial ovarian, fallopian tube, or primary peritoneal cancer at the Norfolk and Norwich University Hospital, a tertiary referral cancer centre in the United Kingdom from November 2012 to June 2016.

Results

Over a 42-month period, 135 consecutive patients underwent cytoreductive surgery for stage IIIC and IV ovarian, fallopian tube, or primary peritoneal cancer. The median age of the patients was 69 years. 47.4% of the patients underwent diaphragmatic peritonectomy and/or resection, 20% underwent splenectomy, 14.1% had excision of disease from porta hepatis and celiac axis, and 5.2% of the patients had gastrectomy. Cytoreduction to no macroscopic visible disease (complete) and to disease with greater tumour diameter of less than 1 cm (optimal) was achieved in 54.1 and 34.1% of the cases, respectively. Without incorporating surgical procedures in the upper abdomen (‘ultra-radical’), the combined rate of complete and optimal cytoreduction would be only 33.3%.

Conclusions

Up to 50.4% of the patients in this study required at least one surgical procedure classified as ultra-radical, emphasizing the importance of cytoreductive surgery in the upper abdomen in management of women with stage IIIC and IV ovarian, fallopian tube, and primary peritoneal cancer.

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Acknowledgements

No grants or funds were used to complete this project.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Hilary L. Turnbull, Nikolaos Akrivos, Timothy J. Duncan, Joaquin J. Nieto & Nikolaos Burbos

  2. Department of Hepatobiliary Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Simon Wemyss-Holden

  3. Department of Anaesthetics and Critical Care, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Balachandra Maiya

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  1. Hilary L. Turnbull
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Correspondence to Hilary L. Turnbull.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

All procedures being performed were part of routine practice in our institution. The data collection and analysis were done in keeping with our institutional clinical governance protocols, and the results were presented to the Trust Board meeting as recommended by NICE Interventional Procedure Guidance 470.

Informed consent

Informed consent was obtained from all individual participants included in this study; this consent was for the procedures being performed as part of their routine care.

Funding

This study did not receive or require any funding.

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Turnbull, H.L., Akrivos, N., Wemyss-Holden, S. et al. The impact of ultra-radical surgery in the management of patients with stage IIIC and IV epithelial ovarian, fallopian tube, and peritoneal cancer. Arch Gynecol Obstet 295, 681–687 (2017). https://doi.org/10.1007/s00404-016-4265-9

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  • DOI: https://doi.org/10.1007/s00404-016-4265-9

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