Continuous improvement in primary Debulking surgery for advanced ovarian cancer: Do increased complete gross resection rates independently lead to increased progression-free and overall survival?
Gynecol Oncol
; 151(1): 24-31, 2018 10.
Article
en En
| MEDLINE
| ID: mdl-30126704
ABSTRACT
OBJECTIVES:
To assess complete gross resection (CGR) rates and survival outcomes in patients with advanced ovarian cancer who underwent primary debulking surgery (PDS) during a 13-year period in which specific changes to surgical paradigm were implemented.METHODS:
We identified all patients with stage IIIB-IV high-grade ovarian carcinoma who underwent PDS at our institution, with the intent of maximal cytoreduction, from 1/2001-12/2013. Patients were categorized by year of PDS based on the implementation of surgical changes to our approach to ovarian cancer debulking (Group 1, 2001-2005; Group 2, 2006-2009; Group 3, 2010-2013).RESULTS:
Among 978 patients, 78% had stage IIIC disease and 89% had disease of serous histology. Carcinomatosis was found in 81%, and 60% had bulky upper abdominal disease (UAD). Compared to Group 1, those who underwent PDS during the latter 2 time periods had higher ASA scores (pâ¯<â¯0.001), higher-stage disease (pâ¯<â¯0.001), and more often had carcinomatosis (pâ¯=â¯0.015) and bulky UAD (pâ¯=â¯0.009). CGR rates for Groups 1-3 increased from 29% to 40% to 55%, respectively (pâ¯<â¯0.001). Five-year progression-free survival (PFS) rates increased over time (15%, 16%, and 20%, respectively; pâ¯=â¯0.199), as did 5-year overall survival (OS) rates (40%, 44%, and 56%, respectively; pâ¯<â¯0.001). On multivariable analysis, CGR was independently associated with PFS (pâ¯<â¯0.001) and OS (pâ¯<â¯0.001).CONCLUSIONS:
Despite higher-stage disease and greater tumor burden, CGR rates, PFS and OS for patients who underwent PDS increased over a 13-year period. Surgical paradigm shifts implemented specifically to achieve more complete surgical cytoreduction are likely the reason for these improvements.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_endocrine_disorders
/
6_ovary_cancer
Asunto principal:
Neoplasias Ováricas
/
Carcinoma
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Procedimientos Quirúrgicos de Citorreducción
Tipo de estudio:
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
Gynecol Oncol
Año:
2018
Tipo del documento:
Article
País de afiliación:
Estados Unidos