Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach.

OBJECTIVE: To determine the impact of the incorporation of extensive upper abdominal debulking procedures on the rates of optimal primary cytoreduction and complications in stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal carcinomas.
METHODS: Two groups of patients were identified for comparison. Group 1, the control group, consisted of 70 consecutive patients who underwent "standard" primary cytoreductive surgery before May 2000. Group 2, the study group, was composed of 70 consecutive patients who underwent surgery after January 2001, during which time, a more comprehensive debulking of upper abdominal disease was used, including diaphragm stripping/resection, splenectomy, distal pancreatectomy, liver resection, resection of porta hepatis tumor, and cholecystectomy.
RESULTS: The median age of the entire cohort was 60 years (range, 36-88 years). The majority had stage IIIC disease (86%) and serous histology (76%). Optimal cytoreduction (residual disease </=1 cm) rates were 50% for group 1 and 76% for group 2 (P < 0.01). Patients in group 2 were more likely to have undergone extensive procedure(s) (27% versus 3%; P < 0.001). Operative time and estimated blood loss were greater in group 2 than group 1 (264 versus 174 min, 880 versus 460 cc, respectively; P < 0.001 for both). Complication rates and length of hospitalization were not significantly different between the two groups.
CONCLUSION: The use of extensive upper abdominal surgical procedures significantly increased the rate of optimal primary cytoreduction. Although operative time and estimated blood loss were increased, the rate of major complications and length of hospitalization remained the same.