Christina Fotopoulou1,2, Benjamin P Jones3, Konstantinos Savvatis4, Jeremy Campbell5, Maria Kyrgiou3,6, Alan Farthing3, Stephen Brett7, Rene Roux8, Marcia Hall8, Gordon Rustin8, Hani Gabra3,6, Long Jiao9, Richard Stümpfle7. 1. West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK. chfotopoulou@gmail.com. 2. Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK. chfotopoulou@gmail.com. 3. West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK. 4. Department of Cardiology, Barts Healthcare NHS Trust Hospital, London, UK. 5. Department of Anesthetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 OHS, UK. 6. Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK. 7. Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK. 8. Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK. 9. Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, W12 0HS, UK.
Abstract
OBJECTIVE: To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center. METHODS/MATERIALS: A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis. RESULTS: We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19-91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100-540 min). Median surgical complexity score was 10 (range 5-15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0-104) and 8 days (range 4-118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks. CONCLUSIONS: Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses.
OBJECTIVE: To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center. METHODS/MATERIALS: A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis. RESULTS: We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19-91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100-540 min). Median surgical complexity score was 10 (range 5-15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0-104) and 8 days (range 4-118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks. CONCLUSIONS: Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses.
Entities:
Keywords:
Albumin; Cytoreduction; Morbidity; Mortality; Multivisceral; Ovarian cancer
Authors: Paula Cunnea; Tommy Gorgy; Konstantinos Petkos; Sally A N Gowers; Haonan Lu; Cristina Morera; Wen Wu; Phillip Lawton; Katherine Nixon; Chi Leng Leong; Flavia Sorbi; Lavinia Domenici; Andrew Paterson; Ed Curry; Hani Gabra; Martyn G Boutelle; Emmanuel M Drakakis; Christina Fotopoulou Journal: Sci Rep Date: 2018-10-02 Impact factor: 4.379
Authors: Marcia Hall; Konstantinos Savvatis; Katherine Nixon; Maria Kyrgiou; Kuhan Hariharan; Malcolm Padwick; Owen Owens; Paula Cunnea; Jeremy Campbell; Alan Farthing; Richard Stumpfle; Ignacio Vazquez; Neale Watson; Jonathan Krell; Hani Gabra; Gordon Rustin; Christina Fotopoulou Journal: Ann Surg Oncol Date: 2019-06-26 Impact factor: 5.344