Thomas Boerner1, Olga T Filippova1, Andrew J Chi1, Alexia Iasonos2, Qin C Zhou2, Kara Long Roche3, Oliver Zivanovic3, Bernard J Park4, James Huang4, David R Jones4, Nadeem R Abu-Rustum3, Ginger Gardner3, Yukio Sonoda3, Dennis S Chi5. 1. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA. 4. Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 5. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA. Electronic address: chid@mskcc.org.
Abstract
OBJECTIVES: We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. METHODS: Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01-01/19. Differences between treatment groups were tested using standard statistical techniques. RESULTS: One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8-51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5-87.8) vs. 37.4 months (95% CI: 33.3-45.2); p = .016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14-4.18; p = .019) and age ≥ 65 (HR 1.98, 95% CI: 1.16-3.40; p = .013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). CONCLUSIONS: VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions.
OBJECTIVES: We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. METHODS: Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01-01/19. Differences between treatment groups were tested using standard statistical techniques. RESULTS: One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8-51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5-87.8) vs. 37.4 months (95% CI: 33.3-45.2); p = .016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14-4.18; p = .019) and age ≥ 65 (HR 1.98, 95% CI: 1.16-3.40; p = .013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). CONCLUSIONS: VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions.
Authors: J I Akahira; H Yoshikawa; Y Shimizu; R Tsunematsu; T Hirakawa; H Kuramoto; K Shiromizu; K Kuzuya; T Kamura; Y Kikuchi; S Kodama; K Yamamoto; S Sato Journal: Gynecol Oncol Date: 2001-06 Impact factor: 5.482
Authors: A R Munkarah; A V Hallum; M Morris; T W Burke; C Levenback; E N Atkinson; J T Wharton; D M Gershenson Journal: Gynecol Oncol Date: 1997-01 Impact factor: 5.482
Authors: D S Chi; E L Eisenhauer; J Lang; J Huh; L Haddad; N R Abu-Rustum; Y Sonoda; D A Levine; M Hensley; R R Barakat Journal: Gynecol Oncol Date: 2006-05-22 Impact factor: 5.482
Authors: William E Winter; G Larry Maxwell; Chunqiao Tian; Michael J Sundborg; G Scott Rose; Peter G Rose; Stephen C Rubin; Franco Muggia; William P McGuire Journal: J Clin Oncol Date: 2007-11-19 Impact factor: 44.544
Authors: Renee A Cowan; Jill Tseng; Vijayashree Murthy; Radhika Srivastava; Kara C Long Roche; Oliver Zivanovic; Ginger J Gardner; Dennis S Chi; Bernard J Park; Yukio Sonoda Journal: Gynecol Oncol Date: 2017-09-06 Impact factor: 5.482
Authors: Ioannis Karampinis; Anna Dionysopoulou; Christian Galata; Katrin Almstedt; Maurizio Grilli; Annette Hasenburg; Eric D Roessner Journal: Thorac Cancer Date: 2022-02-22 Impact factor: 3.500