Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma

Abstract

Background: The survival effects of combined organ resection in cytoreductive surgery for advanced ovarian carcinoma with regard to the site and the number of organs involved have not yet been clarified.

Methods: Data obtained from 143 patients with stage III/IV ovarian carcinoma were used for analysis. Combined organ resection (COR) was employed in 21 patients in whom optimal cytoreduction (defined as a residuum <or=2 cm in diameter) was expected to be achieved by the procedure.

Results: The tumors were optimally cytoreduced in 98 (68.5%) of 143 patients, either in primary surgery ( n = 53) or in interval cytoreductive surgery ( n = 45). The overall survival of patients with optimal cytoreduction was significantly higher than that of patients with nonoptimal cytoreduction ( P < 0.01). There was no significant difference between the survival of patients in the optimal primary cytoreduction group and that of patients in the optimal interval cytoreduction group. The survival of stage III patients who underwent optimal surgery with COR was comparable to that of stage III patients who underwent optimal surgery without COR and was better than that of stage III patients who underwent nonoptimal surgery ( P < 0.01). However, no effect of COR on the survival of stage IV patients was found. In the group of stage III patients who underwent optimal surgery with COR, the survival time tended to be shorter in patients who had upper abdominal organ resections ( P = 0.059), and it was significantly shorter in patients who underwent resections of two or more organs ( P = 0.0299). There was no operative mortality in any of the patients who underwent COR.

Conclusion: Although COR has therapeutic significance for stage III ovarian carcinoma, the survival periods of patients with stage III ovarian carcinoma who have undergone additional upper abdominal organ resections, or two or more organ resections, may be shorter than the survival periods of patients with stage III ovarian carcinoma who have undergone resection of a single non-upper-abdominal organ.