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Evaluation of pelvic posterior exenteration in the management of advanced-stage ovarian cancer

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Abstract

Purpose

The main aim of this study was to show the interest of pelvic posterior exenteration to obtain complete resection of the tumor in case of invasion of the rectum by contiguity in advanced-stage ovarian cancer. The secondary aim was to determine the morbidity of this surgery.

Methods

It is a multicentric, retrospective study of a series of 41 patients, who underwent posterior pelvectomy for advanced-stage ovarian cancer, over a period of 18 years, from July 1989 to July 2007.

Results

The surgery resulted in macroscopically complete resection in 19 patients (46.34%), a residual tumor <2 cm in 19 patients (46.34%) and >2 cm in 3 patients (7.32%). In 34 patients (34/41), digestive continuity with satisfactory anal sphincter function was restored immediately or in the short term. The mean delay to the start of complementary treatment was 36 days. Median overall survival was 33 months.

Conclusion

The main aim of surgery for ovarian peritoneal carcinomatosis is to obtain a complete resection. In the case of direct invasion of the rectum by contiguity, when there is no cleavage plane between the uterus and the rectum, pelvic posterior exenteration is an effective method to achieve this objective. Morbidity is relatively high, but acceptable given the poor prognosis of this disease, the improved survival after surgery, and improvements in post-operative quality of life and functions.

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References

  1. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20(5):1248–1259

    Article  PubMed  Google Scholar 

  2. Du Bois A, Harter P (2006) The role of surgery in advanced and recurrent ovarian cancer. Ann Oncol 17(Suppl 10):x235–x240

    Article  PubMed  Google Scholar 

  3. Eisenkop SM, Friedman RL, Wang HJ (1998) Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol 69(2):103–108

    Article  CAS  PubMed  Google Scholar 

  4. Griffiths CT (1975) Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 42:101–104

    CAS  PubMed  Google Scholar 

  5. Griffiths CT, Parker LM, Fuller AF Jr (1979) Role of cytoreductive surgical treatment in the management of advanced ovarian cancer. Cancer Treat Rep 63(2):235–240

    CAS  PubMed  Google Scholar 

  6. Hacker NF, Berek JS, Lagasse LD, Nieberg RK, Elashoff RM (1983) Primary cytoreductive surgery for epithelial ovarian cancer. Obstet Gynecol 61(4):413–420

    CAS  PubMed  Google Scholar 

  7. Skirnisdottir I, Sorbe B (2007) Prognostic factors for surgical outcome and survival in 447 women treated for advanced (FIGO-stages III–IV) epithelial ovarian carcinoma. Int J Oncol 30(3):727–734

    PubMed  Google Scholar 

  8. Wimberger P, Lehmann N, Kimmig R, Burges A, Meier W, Du Bois BA (2007) Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 106(1):69–74

    Article  PubMed  Google Scholar 

  9. Scholz HS, Tasdemir H, Hunlich T, Turnwald W, Both A, Egger H (2007) Multivisceral cytoreductive surgery in FIGO stages IIIC and IV epithelial ovarian cancer: results and 5-year follow-up. Gynecol Oncol 106(3):591–595

    Article  PubMed  Google Scholar 

  10. Du Bois BA, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J (2009) 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 115(6):1234–1244

    Article  CAS  PubMed  Google Scholar 

  11. Pomel C, Barton DP, McNeish I, Shepherd J (2008) A statement for extensive primary cytoreductive surgery in advanced ovarian cancer. BJOG 115(7):808–810

    Article  CAS  PubMed  Google Scholar 

  12. Carmignani CP, Sugarbaker PH (2004) Comprehensive approach to advanced primary and recurrent ovarian cancer: a personal experience. Expert Rev Anticancer Ther 4(3):477–487

    Article  PubMed  Google Scholar 

  13. Sugarbaker PH (1996) Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent ovarian cancer. Cancer Treat Res 81:75–87

    CAS  PubMed  Google Scholar 

  14. Hudson CN, Dendy PP (1974) Aspects of treatment of more advanced cases of ovarian cancer. Proc R Soc Med 67(8):798–801

    CAS  PubMed  Google Scholar 

  15. Hudson CN (1978) The place of surgery in the treatment of ovarian cancer. Clin Obstet Gynaecol 5(3):695–708

    CAS  PubMed  Google Scholar 

  16. Crawford SC, Vasey PA, Paul J, Hay A, Davis JA, Kaye SB (2005) Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 trial. J Clin Oncol 23(34):8802–8811

    Article  PubMed  Google Scholar 

  17. Bossard N, Velten M, Remontet L, Belot A, Maarouf N, Bouvier AM et al (2007) Survival of cancer patients in France: a population-based study from The Association of the French Cancer Registries (FRANCIM). Eur J Cancer 43(1):149–160

    Article  CAS  PubMed  Google Scholar 

  18. Coleman MP, Gatta G, Verdecchia A, Esteve J, Sant M, Storm H et al (2003) EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century. Ann Oncol 14(Suppl 5):v128–v149

    Article  PubMed  Google Scholar 

  19. Colonna M, Hedelin G, Esteve J, Grosclaude P, Launoy G, Buemi A et al (2000) National cancer prevalence estimation in France. Int J Cancer 87(2):301–304

    Article  CAS  PubMed  Google Scholar 

  20. Remontet L, Esteve J, Bouvier AM, Grosclaude P, Launoy G, Menegoz F et al (2003) Cancer incidence and mortality in France over the period 1978–2000. Rev Epidemiol Sante Publique 51(1 Pt 1):3–30

    CAS  PubMed  Google Scholar 

  21. Tretarre B, Remontet L, Menegoz F, Mace-Lesec’h J, Grosclaude P, Buemi A et al (2005) Ovarian cancer: incidence and mortality in France. J Gynecol Obstet Biol Reprod (Paris) 34(2):154–161

    CAS  Google Scholar 

  22. Bridges J, Oram D (1993) Management of advanced gynaecological malignancies. Br J Hosp Med 49(3):191–199

    CAS  PubMed  Google Scholar 

  23. Buttarelli M, Houvenaeghel G, Lelievre L, Jacquemier J, Guiramand J, Delpero JR (2006) Pelvic posterior exenteration with immediate colo-rectal anastomosis: is it justified and feasible in advanced stage ovarian carcinoma? Ann Chir 131(8):431–436

    Article  CAS  PubMed  Google Scholar 

  24. Eisenkop SM, Nalick RH, Teng NN (1991) Modified posterior exenteration for ovarian cancer. Obstet Gynecol 78(5 Pt 1):879–885

    CAS  PubMed  Google Scholar 

  25. Soper JT, Couchman G, Berchuck A, Clarke-Pearson D (1991) The role of partial sigmoid colectomy for debulking epithelial ovarian carcinoma. Gynecol Oncol 41(3):239–244

    Article  CAS  PubMed  Google Scholar 

  26. Mourton SM, Temple LK, bu-Rustum NR, Gemignani ML, Sonoda Y, Bochner BH et al (2005) Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer. Gynecol Oncol 99(3):608–614

    Article  PubMed  Google Scholar 

  27. Mirhashemi R, Averette HE, Estape R, Angioli R, Mahran R, Mendez L et al (2000) Low colorectal anastomosis after radical pelvic surgery: a risk factor analysis. Am J Obstet Gynecol 183(6):1375–1379

    Article  CAS  PubMed  Google Scholar 

  28. Blythe JG, Wahl TP (1982) Debulking surgery: does it increase the quality of survival? Gynecol Oncol 14(3):396–408

    Article  CAS  PubMed  Google Scholar 

  29. Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC (2000) Second-look laparotomy after modified posterior exenteration: patterns of persistence and recurrence in patients with stage III and stage IV ovarian cancer. Am J Obstet Gynecol 182(6):1321–1327

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We thank Philip Bastable for the help in revising the manuscript.

Conflict of interest statement

None.

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Authors and Affiliations

  1. Department of Oncological Surgery, Georges François Leclerc Anticancer Center, 1, rue du Professeur Marion, 21000, Dijon, France

    Hervé Tixier, Jean Fraisse, Sylvain Causeret, Catherine Loustalot & Jean Cuisenier

  2. Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 Bd Maréchal de Lattre de Tassigny, BP 77908, 21079, Dijon Cedex, France

    Hervé Tixier, Paul Sagot & Serge Douvier

  3. INSERM UMR 866, Faculty of Medicine, 7 boulevard Jeanne d’Arc, 21000, Dijon, France

    Hervé Tixier & Bruno Chauffert

  4. Department of Medical Oncology, Georges François Leclerc Anticancer Center, 1, rue du Professeur Marion, 21000, Dijon, France

    Bruno Chauffert & Françoise Mayer

  5. Department of Biostatistics, Georges François Leclerc Anticancer Center, 1, rue du Professeur Marion, 21000, Dijon, France

    Coralie Deville & Franck Bonnetain

  6. EA 4184, Epidémiologie des populations, IFR Santé STIC, Faculty of Medicine, 7 boulevard Jeanne d’Arc, 21000, Dijon, France

    Paul Sagot

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  1. Hervé Tixier
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  2. Jean Fraisse
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  7. Coralie Deville
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  9. Paul Sagot
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  10. Serge Douvier
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  11. Jean Cuisenier
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Correspondence to Hervé Tixier.

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Tixier, H., Fraisse, J., Chauffert, B. et al. Evaluation of pelvic posterior exenteration in the management of advanced-stage ovarian cancer. Arch Gynecol Obstet 281, 505–510 (2010). https://doi.org/10.1007/s00404-009-1175-0

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  • DOI: https://doi.org/10.1007/s00404-009-1175-0

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