Skip to main content
SpringerLink
Log in

What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer?

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

Abstract

Purpose

To compare the impact, in terms of survival, of complete cytoreduction after primary debulking surgery (PDS) and interval debulking surgery (IDS) in patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stages III–IV) by reviewing the recent literature.

Methods

A search of the PubMed database during the last 7 years (2008–2014) was carried out looking for studies specifically showing data on median survival or disease-free survival after complete cytoreduction after either PDS or IDS.

Results

We found 24 publications including 14,182 patients with stages III to IV ovarian cancer. A total of 11871 patients (83.7 %) underwent PDS and 2311 (16.3 %) underwent interval debulking after neoadjuvant chemotherapy. A total of 4684 patients (33 %) were considered completely resected with microscopic residual disease. After PDS, the weighted average of median overall and progression-free survival was 43 and 17 months, respectively, for the whole group. After IDS, median and progression-free survival were 33 and 14 months. The rate of complete cytoreduction after PDS was inferior to the obtained in patients with IDS (27 vs. 59 %). However, the median survival in patients with complete cytoreduction with primary cytoreduction was 23 months longer than in the group with interval debulking (69 vs. 45 months).

Conclusions

Complete cytoreduction after IDS yields a inferior outcome in terms of median survival than PDS of almost 2 years. Despite the higher rate of complete resection, IDS apparently fails to improve the results obtained by primary debulking.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lowe KA, Chia VM, Taylor A, et al. An international assessment of ovarian cancer incidence and mortality. Gynecol Oncol. 2013;130:107–14.

    Article  PubMed  Google Scholar 

  2. Chi DS, Eisenhauer EL, Zivanovic O, et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol. 2009;114:26–31.

    Article  PubMed  Google Scholar 

  3. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.

    Article  PubMed  Google Scholar 

  4. Hamilton CA, Miller A, Miller C, et al. The impact of disease distribution on survival in patients with stage III epithelial ovarian cancer cytoreduced to microscopic residual: a Gynecologic Oncology Group study. Gynecol Oncol. 2011;122:521–6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol. 2013;130:493–8.

    Article  PubMed  Google Scholar 

  6. Barlin JN, Long KC, Tanner EJ, et al. Optimal (≤ 1 cm) but visible residual disease: is extensive debulking warranted? Gynecol Oncol. 2013;130:284–8.

    Article  CAS  PubMed  Google Scholar 

  7. Zivanovic O, Eisenhauer EL, Zhou Q, et al. The impact of bulky upper abdominal disease cephalad to the greater omentum on surgical outcome for stage IIIC epithelial ovarian, fallopian tube, and primary peritoneal cancer. Gynecol Oncol. 2008;108:287–92.

    Article  PubMed  Google Scholar 

  8. Vergote I, Tropé CG, Amant F, et al; European Organization for Research and Treatment of Cancer–Gynaecological Cancer Group; NCIC Clinical Trials Group. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363:943–53.

    Article  CAS  PubMed  Google Scholar 

  9. Cornelis S, Van Calster B, Amant F, Leunen K, van der Zee AG, Vergote I. Role of neoadjuvant chemotherapy in the management of stage IIIC–IV ovarian cancer: survey results from the members of the European Society of Gynecological Oncology. Int J Gynecol Cancer. 2012;22:407–16.

    Article  PubMed  Google Scholar 

  10. Winter WE, Maxwell GL, Tian C, et al; Gynecologic Oncology Group. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2008;26:83–9.

    Article  PubMed  Google Scholar 

  11. Colombo PE, Mourregot A, Fabbro M, et al. Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol. 2009;35:135–43.

    Article  PubMed  Google Scholar 

  12. 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 

  13. Bookman MA, Brady MF, McGuire WP, et al. Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a phase III trial of the Gynecologic Cancer Intergroup. J Clin Oncol. 2009;27:1419–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Onda T, Yoshikawa H, Yasugi T, Matsumoto K, Taketani Y. The optimal debulking after neoadjuvant chemotherapy in ovarian cancer: proposal based on interval look during upfront surgery setting treatment. Jpn J Clin Oncol. 2010;40:36–41.

    Article  PubMed  Google Scholar 

  15. Peiretti M, Zanagnolo V, Aletti GD, et al. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: surgical and oncological outcomes. Single institution experience. Gynecol Oncol. 2010;119:259–64.

    Article  PubMed  Google Scholar 

  16. Sehouli J, Savvatis K, Braicu EI, Schmidt SC, Lichtenegger W, Fotopoulou C. Primary versus interval debulking surgery in advanced ovarian cancer: results from a systematic single-center analysis. Int J Gynecol Cancer. 2010;20:1331–40.

    PubMed  Google Scholar 

  17. Rauh-Hain JA, Rodriguez N, Growdon WB, et al. Primary debulking surgery versus neoadjuvant chemotherapy in stage IV ovarian cancer. Ann Surg Oncol. 2012;19:959–65.

    Article  PubMed  Google Scholar 

  18. Luyckx M, Leblanc E, Filleron T, et al. Maximal cytoreduction in patients with FIGO stage IIIC to stage IV ovarian, fallopian, and peritoneal cancer in day-to-day practice: a retrospective French multicentric study. Int J Gynecol Cancer. 2012;22:1337–43.

    Article  PubMed  Google Scholar 

  19. Chi DS, Musa F, Dao F, et al. An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). Gynecol Oncol. 2012;124:10–4.

    Article  PubMed  Google Scholar 

  20. . Chang SJ, Bristow RE, Ryu HS. Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer. Ann Surg Oncol. 2012;19:4059–67.

    Article  PubMed  Google Scholar 

  21. . Tropé CG, Elstrand MB, Sandstad B, Davidson B, Oksefjell H. Neoadjuvant chemotherapy, interval debulking surgery or primary surgery in ovarian carcinoma FIGO stage IV? Eur J Cancer. 2012;48:2146–54.

    Article  PubMed  Google Scholar 

  22. Rauh-Hain JA, Nitschmann CC, Worley MJ Jr, et al. Platinum resistance after neoadjuvant chemotherapy compared to primary surgery in patients with advanced epithelial ovarian carcinoma. Gynecol Oncol. 2013;129:63–8.

    Article  CAS  PubMed  Google Scholar 

  23. Muraji M, Sudo T, Iwasaki S, et al. Histopathology predicts clinical outcome in advanced epithelial ovarian cancer patients treated with neoadjuvant chemotherapy and debulking surgery. Gynecol Oncol. 2013;131:531–4.

    Article  PubMed  Google Scholar 

  24. Keyver-Paik MD, Zivanovic O, Rudlowski C, et al. Interval debulking surgery in patients with Federation of Gynecology and Obstetrics (FIGO) stage IIIC and IV ovarian cancer. Onkologie. 2013;36:324–32.

    Article  PubMed  Google Scholar 

  25. Fagotti A, Vizzielli G, Fanfani F, et al. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. Gynecol Oncol. 2013;131:341–6.

    Article  CAS  PubMed  Google Scholar 

  26. Da Costa Miranda V, de Souza Fêde ÂB, Dos Anjos CH, et al. Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: safety and effectiveness. Gynecol Oncol. 2014;132:287–91.

    Article  Google Scholar 

  27. Usami T, Kato K, Taniguchi T, et al. Recurrence patterns of advanced ovarian, fallopian tube, and peritoneal cancers after complete cytoreduction during interval debulking surgery. Int J Gynecol Cancer. 2014;24:991–6.

    Article  PubMed  Google Scholar 

  28. Rosen B, Laframboise S, Ferguson S, et al. The impacts of neoadjuvant chemotherapy and of debulking surgery on survival from advanced ovarian cancer. Gynecol Oncol. 2014;134:462–7.

    Article  CAS  PubMed  Google Scholar 

  29. Petrillo M, Zannoni GF, Tortorella L, et al. Prognostic role and predictors of complete pathologic response to neoadjuvant chemotherapy in primary unresectable ovarian cancer. Am J Obstet Gynecol. 2014;211:632.

    PubMed  Google Scholar 

  30. Fagö-Olsen CL, Ottesen B, Kehlet H, et al. Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study. Gynecol Oncol. 2014;132:292–8.

    Article  PubMed  Google Scholar 

  31. Stoeckle E, Bourdarias L, Guyon F, et al. Progress in survival outcomes in patients with advanced ovarian cancer treated by neo-adjuvant platinum/taxane-based chemotherapy and late interval debulking surgery. Ann Surg Oncol. 2014;21:629–36.

    Article  PubMed  Google Scholar 

  32. Stuart GC, Kitchener H, Bacon M, et al; participants of 4th Ovarian Cancer Consensus Conference (OCCC); Gynecologic Cancer Inter Group. 2010 Gynecologic Cancer Inter Group (GCIG) consensus statement on clinical trials in ovarian cancer: report from the Fourth Ovarian Cancer Consensus Conference. Int J Gynecol Cancer. 2011;21:750–5.

    Google Scholar 

  33. Wimberger P, Wehling M, Lehmann N, et al. Influence of residual tumor on outcome in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Ann Surg Oncol. 2010;17:1642–8.

    Article  PubMed  Google Scholar 

  34. Rose PG, Nerenstone S, Brady MF, et al; Gynecologic Oncology Group. Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med. 2004;351:2489–97.

    Article  CAS  PubMed  Google Scholar 

  35. Kumar L, Hariprasad R, Kumar S, et al. In: Upfront surgery vs. neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma (EOC): a randomized study (abstract A824). Paper presented at IGCS 13; Prague; 2010.

  36. Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386(9990):249–57.

    Article  PubMed  Google Scholar 

  37. Winter WE, Maxwell GL, Tian C, et al; Gynecologic Oncology Group Study. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621–7.

    Article  PubMed  Google Scholar 

  38. Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Aghajanian C, Barakat RR, Chi DS. The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecol Oncol. 2008;108:276–81.

    Article  CAS  PubMed  Google Scholar 

  39. Cancer Genome Atlas Research Network. Integrated genomic analyses of ovarian carcinoma Nature. 2011;474(7353):609–15.

    Google Scholar 

  40. Petrillo M, Ferrandina G, Fagotti A, et al. Timing and pattern of recurrence in ovarian cancer patients with high tumor dissemination treated with primary debulking surgery versus neoadjuvant chemotherapy. Ann Surg Oncol. 2013;20:3955–60.

    Article  CAS  PubMed  Google Scholar 

  41. Cooke SL, Brenton JD. Evolution of platinum resistance in high grade serous ovarian cancer. Lancet Oncol. 2011;12:1–6.

    Article  Google Scholar 

  42. Zhang GN, Liu H, Huang JM, et al. TP53 K351N mutation-associated platinum resistance after neoadjuvant chemotherapy in patients with advanced ovarian cancer. Gynecol Oncol. 2014;132:752–7.

    Article  CAS  PubMed  Google Scholar 

  43. Roque DM, Buza N, Glasgow M, et al. Class III β-tubulin overexpression within the tumor microenvironment is a prognostic biomarker for poor overall survival in ovarian cancer patients treated with neoadjuvant carboplatin/paclitaxel. Clin Exp Metastasis. 2014;31:101–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Du Bois A, Marth C, Pfisterer J, et al. Neoadjuvant chemotherapy cannot be regarded as adequate routine therapy strategy of advanced ovarian cancer. Int J Gynecol Cancer. 2012;22:182–5.

    Article  PubMed  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gyecologic Oncology, MD Anderson Cancer Center, Madrid, Spain

    Luis Chiva MD, PhD, Fernando Lapuente MD, Teresa Castellanos MD & Sonsoles Alonso MD, PhD

  2. Department of Oncology, MD Anderson Cancer Center, Madrid, Spain

    Antonio Gonzalez-Martin MD

Authors
  1. Luis Chiva MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando Lapuente MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teresa Castellanos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sonsoles Alonso MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Gonzalez-Martin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis Chiva MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiva, L., Lapuente, F., Castellanos, T. et al. What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer?. Ann Surg Oncol 23, 1666–1673 (2016). https://doi.org/10.1245/s10434-015-5051-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-5051-9

Keywords

Search

Navigation