BACKGROUND: Postoperative tumor-residual-mass is the most important prognostic factor in epithelial ovarian cancer (EOC). Aim of our study was to define risk factors for incomplete tumor resection in advanced primary EOC. PATIENTS & METHODS: A validated intraoperative documentation tool ("Intraoperative-Mapping of Ovarian-Cancer" = "IMO") was applied to systematically evaluate intraabdominal tumor dissemination pattern, maximal tumor load, tumor residuals and operative morbidity for all EOC-patients who underwent primary surgery in our institution during 09/2000-08/2009. Univariate- and multivariate analysis were performed to identify independent risk factors of incomplete tumor resection and operative complications. RESULTS: We evaluated 360 consecutive EOC-patients of FIGO-stage-III/IV. In 221(61%) patients a complete tumor resection could be obtained. In 50(14%) patients tumor residuals were <0.5 cm. Sixty (17%) patients developed a major (14%) complication. Multivariate analysis identified intestinal resection (OR:2.0; 95%CI:1.14-3.4; p = 0.01) and macroscopical tumor residuals (OR:0.5; 95%CI:0.2-1.2; p = 0.05) as independent predictors of major operative morbidity. Tumor dissemination pattern and maximal tumor load were significantly different between tumor-free and not-tumor-free operated patients, with less extrapelvic tumor involvement in the tumor-free group (p < 0.001). More than 4 IMO-fields of tumor involvement (OR:3.3; 95%CI:1.5-7.0; p = 0.002) were identified to be of predictive significance for incomplete tumor resection. FIGO-stage, histology, age, CA125-levels, bowel resection and ascites did not affect optimal tumor resectability. CONCLUSIONS: Tumor expanding in multiple (>4) abdominal quadrants was the major negative predictors for complete tumor resection in primary EOC-patients. Bowel resection and macroscopical tumor residuals were of predictive value for a higher operative major morbidity. Identifying high-risk patients for suboptimal tumor resection and operative complications may improve surgical outcome in advanced primary EOC.
BACKGROUND: Postoperative tumor-residual-mass is the most important prognostic factor in epithelial ovarian cancer (EOC). Aim of our study was to define risk factors for incomplete tumor resection in advanced primary EOC. PATIENTS & METHODS: A validated intraoperative documentation tool ("Intraoperative-Mapping of Ovarian-Cancer" = "IMO") was applied to systematically evaluate intraabdominal tumor dissemination pattern, maximal tumor load, tumor residuals and operative morbidity for all EOC-patients who underwent primary surgery in our institution during 09/2000-08/2009. Univariate- and multivariate analysis were performed to identify independent risk factors of incomplete tumor resection and operative complications. RESULTS: We evaluated 360 consecutive EOC-patients of FIGO-stage-III/IV. In 221(61%) patients a complete tumor resection could be obtained. In 50(14%) patientstumor residuals were <0.5 cm. Sixty (17%) patients developed a major (14%) complication. Multivariate analysis identified intestinal resection (OR:2.0; 95%CI:1.14-3.4; p = 0.01) and macroscopical tumor residuals (OR:0.5; 95%CI:0.2-1.2; p = 0.05) as independent predictors of major operative morbidity. Tumor dissemination pattern and maximal tumor load were significantly different between tumor-free and not-tumor-free operated patients, with less extrapelvic tumor involvement in the tumor-free group (p < 0.001). More than 4 IMO-fields of tumor involvement (OR:3.3; 95%CI:1.5-7.0; p = 0.002) were identified to be of predictive significance for incomplete tumor resection. FIGO-stage, histology, age, CA125-levels, bowel resection and ascites did not affect optimal tumor resectability. CONCLUSIONS:Tumor expanding in multiple (>4) abdominal quadrants was the major negative predictors for complete tumor resection in primary EOC-patients. Bowel resection and macroscopical tumor residuals were of predictive value for a higher operative major morbidity. Identifying high-risk patients for suboptimal tumor resection and operative complications may improve surgical outcome in advanced primary EOC.
Authors: J Brian Szender; Tiffany Emmons; Sarah Belliotti; Danielle Dickson; Aalia Khan; Kayla Morrell; A N M Nazmul Khan; Kelly L Singel; Paul C Mayor; Kirsten B Moysich; Kunle Odunsi; Brahm H Segal; Kevin H Eng Journal: Gynecol Oncol Date: 2017-06-16 Impact factor: 5.482
Authors: Martin Wagner; Benjamin Friedrich Berthold Mayer; Sebastian Bodenstedt; Katherine Stemmer; Arash Fereydooni; Stefanie Speidel; Rüdiger Dillmann; Felix Nickel; Lars Fischer; Hannes Götz Kenngott Journal: Surg Endosc Date: 2018-03-05 Impact factor: 4.584
Authors: David M Hyman; Kara C Long; Edward J Tanner; Rachel N Grisham; Angela G Arnold; Jasmine Bhatia; Mary F Phillips; David R Spriggs; Robert A Soslow; Noah D Kauff; Douglas A Levine Journal: Gynecol Oncol Date: 2012-05-08 Impact factor: 5.482
Authors: María Martín-Cameán; Elsa Delgado-Sánchez; Antonio Piñera; Maria Dolores Diestro; Javier De Santiago; Ignacio Zapardiel Journal: Ecancermedicalscience Date: 2016-08-17
Authors: A González Martín; A Redondo; M Jurado; A De Juan; I Romero; I Bover; J M Del Campo; A Cervantes; Y García; J A López-Guerrero; C Mendiola; J Palacios; M J Rubio; A Poveda Velasco Journal: Clin Transl Oncol Date: 2013-03-07 Impact factor: 3.405
Authors: Christos Iavazzo; Alexandros Fotiou; Victoria Psomiadou; Sofia Lekka; Dimitrios Katsanos; John Spiliotis Journal: Indian J Surg Oncol Date: 2021-03-03