Fabien Vidal1,2, Haya Al Thani1, Pascale Haddad3, Mathieu Luyckx4, Eberhard Stoeckle5, Philippe Morice6, Eric Leblanc7, Fabrice Lecuru8, Emile Daraï9, Jean-Marc Classe10, Christophe Pomel11, Ziyad Mahfoud3, Gwenael Ferron12, Denis Querleu12, Arash Rafii13,14,15. 1. Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. 2. Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. 3. Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. 4. Department of Gynecologic Surgery, Saint Luc Academic Hospital, Catholic University of Louvain, Bruxelles, Belgium. 5. Comprehensive Cancer Center, Department of Surgery, Institut Bergonie, Bordeaux, France. 6. Department of Gynecologic Surgery, Institut Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France. 7. Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France. 8. Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France. 9. Department of Gynecologic Surgery, Tenon Hospital, Paris, France. 10. Department of Surgical Oncology, Centre Gauducheau, Comprehensive Cancer Center, Saint Herblain, France. 11. Department of Surgical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France. 12. Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France. 13. Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. jat2021@qatar-med.cornell.edu. 14. Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. jat2021@qatar-med.cornell.edu. 15. Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, Education City, Doha, Qatar. jat2021@qatar-med.cornell.edu.
Abstract
BACKGROUND: In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. METHODS: Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. RESULTS: Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10(-3)). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. CONCLUSIONS: In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.
BACKGROUND: In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. METHODS: Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. RESULTS: Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10(-3)). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. CONCLUSIONS: In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.