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Comparative Study
. 2018 Oct;151(1):24-31.
doi: 10.1016/j.ygyno.2018.08.014. Epub 2018 Aug 17.

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?

Jill H Tseng  1 , Renee A Cowan  1 , Qin Zhou  2 , Alexia Iasonos  2 , Maureen Byrne  1 , Tracy Polcino  1 , Clarissa Polen-De  1 , Ginger J Gardner  3 , Yukio Sonoda  3 , Oliver Zivanovic  3 , Nadeem R Abu-Rustum  3 , Kara Long Roche  3 , Dennis S Chi  4
Affiliations
Comparative Study

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?

Jill H Tseng et al. Gynecol Oncol. 2018 Oct.

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 (p < 0.001), higher-stage disease (p < 0.001), and more often had carcinomatosis (p = 0.015) and bulky UAD (p = 0.009). CGR rates for Groups 1-3 increased from 29% to 40% to 55%, respectively (p < 0.001). Five-year progression-free survival (PFS) rates increased over time (15%, 16%, and 20%, respectively; p = 0.199), as did 5-year overall survival (OS) rates (40%, 44%, and 56%, respectively; p < 0.001). On multivariable analysis, CGR was independently associated with PFS (p < 0.001) and OS (p < 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.

Keywords: Complete gross resection; Ovarian cancer; Overall survival; Primary debulking surgery; Progression-free survival; Surgical paradigm.

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Conflict of interest statement

Conflict of Interest Statement

Outside the submitted work, Dr. Dennis Chi is on the Medical Advisory Boards of Bovie Medical Co. and Verthermia Inc. The other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
(A) Progression-free survival and (B) overall survival stratified by residual disease. (C) Progression-free survival and (D) overall survival stratified by PDS-Year group. CGR, residual disease 0 mm; Minimal residual, residual disease 1–10 mm; suboptimal, residual disease >10 mm *Log-rank p value **Chi-square p value at 5-year time point PDS, primary debulking surgery; CGR, complete gross resection
See this image and copyright information in PMC

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