Florian Heitz1, Philipp Harter2, Piero F Alesina3, Martin K Walz3, Dietmar Lorenz4, Harald Groeben5, Sebastian Heikaus6, Anette Fisseler-Eckhoff7, Stephanie Schneider8, Beyhan Ataseven8, Christian Kurzeder8, Sonia Prader8, Bianca Beutel9, Alexander Traut2, Andreas du Bois2. 1. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Germany; Department of Gynecology and Gynecologic Oncology, Horst-Schmidt Klinik Wiesbaden, Germany. Electronic address: florian.heitz@gmx.net. 2. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Germany; Department of Gynecology and Gynecologic Oncology, Horst-Schmidt Klinik Wiesbaden, Germany. 3. Department for Surgery and Centre of Minimal Invasive Surgery, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Germany. 4. Department for Surgery, Sana Klinikum Offenbach, Germany; Department for Surgery, Dr. Horst-Schmidt-Kliniken Wiesbaden, Germany. 5. Department of Anesthesia, Critical Care and Pain Medicine, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Germany. 6. Zentrum für Pathologie Essen-Mitte, Germany. 7. Department of Pathology, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany. 8. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Germany. 9. Department of Gynecology and Gynecologic Oncology, Horst-Schmidt Klinik Wiesbaden, Germany.
Abstract
OBJECTIVE: Describing the pattern of and reasons for post-operative tumor residuals in patients with advanced epithelial ovarian cancer (AOC) operated in a specialized gynecologic cancer center following a strategy of maximum upfront debulking followed by systemic chemotherapy. METHODS: All consecutive AOC-patients treated between 2005 and 2015 due to stages FIGO IIIB/IV were included in this single-center analysis. RESULTS: 739 patients were included in this analysis. In 81 (11.0%) patients, chemotherapy had already started before referral. Of the remaining 658 patients, upfront debulking was indicated in 578 patients (87.8%), while 80 patients (12.8%) were classified ineligible for upfront debulking; mostly due to comorbidities. A complete tumor resection was achieved in 66.1% of the 578 patients with upfront surgery, 25.4% had residuals 1-10mm and 8.5% had residuals exceeding 10mm, and 12.5% of patients had multifocal residual disease. Most common localization was small bowel mesentery and serosa (79.8%), porta hepatis/hepatoduodenal ligament (10.1%), liver parenchyma (4.3%), pancreas (8.0%), gastric serosa (3.2%), and tumor surrounding/infiltrating the truncus coeliacus (2.7%); 14.9% of the patients had non-resectable supra diaphragmatic lesions. Size of residual tumor was significantly associated with progression-free and overall survival. CONCLUSIONS: Upfront debulking for AOC followed by systemic chemotherapy was our main treatment strategy in almost 90% of all patients. The majority experienced a benefit by this approach; while 11.7% of patients probably did not. Understanding sites and reason for residual disease may help to develop adequate surgical training programs but also to identify patients that would better benefit from alternative treatment strategies.
OBJECTIVE: Describing the pattern of and reasons for post-operative tumor residuals in patients with advanced epithelial ovarian cancer (AOC) operated in a specialized gynecologic cancer center following a strategy of maximum upfront debulking followed by systemic chemotherapy. METHODS: All consecutive AOC-patients treated between 2005 and 2015 due to stages FIGO IIIB/IV were included in this single-center analysis. RESULTS: 739 patients were included in this analysis. In 81 (11.0%) patients, chemotherapy had already started before referral. Of the remaining 658 patients, upfront debulking was indicated in 578 patients (87.8%), while 80 patients (12.8%) were classified ineligible for upfront debulking; mostly due to comorbidities. A complete tumor resection was achieved in 66.1% of the 578 patients with upfront surgery, 25.4% had residuals 1-10mm and 8.5% had residuals exceeding 10mm, and 12.5% of patients had multifocal residual disease. Most common localization was small bowel mesentery and serosa (79.8%), porta hepatis/hepatoduodenal ligament (10.1%), liver parenchyma (4.3%), pancreas (8.0%), gastric serosa (3.2%), and tumor surrounding/infiltrating the truncus coeliacus (2.7%); 14.9% of the patients had non-resectable supra diaphragmatic lesions. Size of residual tumor was significantly associated with progression-free and overall survival. CONCLUSIONS: Upfront debulking for AOC followed by systemic chemotherapy was our main treatment strategy in almost 90% of all patients. The majority experienced a benefit by this approach; while 11.7% of patients probably did not. Understanding sites and reason for residual disease may help to develop adequate surgical training programs but also to identify patients that would better benefit from alternative treatment strategies.
Authors: Andrew Bryant; Shaun Hiu; Patience T Kunonga; Ketankumar Gajjar; Dawn Craig; Luke Vale; Brett A Winter-Roach; Ahmed Elattar; Raj Naik Journal: Cochrane Database Syst Rev Date: 2022-09-26
Authors: Angelo Di Giorgio; Pierandrea De Iaco; Michele De Simone; Alfredo Garofalo; Giovanni Scambia; Antonio Daniele Pinna; Giorgio Maria Verdecchia; Luca Ansaloni; Antonio Macrì; Paolo Cappellini; Valerio Ceriani; Giorgio Giorda; Daniele Biacchi; Marco Vaira; Mario Valle; Paolo Sammartino Journal: Ann Surg Oncol Date: 2016-11-28 Impact factor: 5.344
Authors: Florian Heitz; Sotirios Lakis; Philipp Harter; Sebastian Heikaus; Jalid Sehouli; Jatin Talwar; Roopika Menon; Beyhan Ataseven; Miriam Bertrand; Stephanie Schneider; Erika Mariotti; Mareike Bommert; Judith N Müller; Sonia Prader; Frauke Leenders; Alexandra Hengsbach; Christian Gloeckner; Elena Ioana Braicu; Lukas C Heukamp; Andreas du Bois; Johannes M Heuckmann Journal: PLoS One Date: 2022-02-07 Impact factor: 3.240