Karen M Mulligan1, Kate Glennon1, Fionán Donohoe1, Yvonne O'Brien1, Brian C Mc Donnell1, Helena C Bartels1, Carolien Vermeulen1, Tom Walsh1, Conor Shields2,3, Orla McCormack2,3, John Conneely2,3, William D Boyd1, Ruaidhrí Mc Vey1, Jurgen Mulsow2,3, Donal J Brennan4,5. 1. Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland. 2. Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland. 3. National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland. 4. Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland. donal.brennan@ucd.ie. 5. National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland. donal.brennan@ucd.ie.
Abstract
BACKGROUND: Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit. METHODS: The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A). RESULTS: This study included 146 patients in cohort A (2006-2015) and 93 patients in cohort B (2017-2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006-2019). CONCLUSIONS: The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
BACKGROUND: Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit. METHODS: The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A). RESULTS: This study included 146 patients in cohort A (2006-2015) and 93 patients in cohort B (2017-2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006-2019). CONCLUSIONS: The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
Authors: Helena C Bartels; Ailin C Rogers; James Postle; Conor Shields; Jurgen Mulsow; John Conneely; Donal J Brennan Journal: Pleura Peritoneum Date: 2019-06-28
Authors: Nicholas Cardillo; Eric J Devor; Silvana Pedra Nobre; Andreea Newtson; Kimberly Leslie; David P Bender; Brian J Smith; Michael J Goodheart; Jesus Gonzalez-Bosquet Journal: Cancers (Basel) Date: 2022-07-21 Impact factor: 6.575