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. 2020 Sep;158(3):608-613.
doi: 10.1016/j.ygyno.2020.05.041. Epub 2020 Jun 6.

A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center team ovary initiative

Alli M Straubhar  1 , Olga T Filippova  1 , Renee A Cowan  1 , Yulia Lakhman  2 , Debra M Sarasohn  2 , Ines Nikolovski  2 , Jean M Torrisi  2 , Weining Ma  2 , Nadeem R Abu-Rustum  3 , Ginger J Gardner  3 , Yukio Sonoda  3 , Oliver Zivanovic  3 , Dennis S Chi  3 , Kara Long Roche  4
Affiliations

A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center team ovary initiative

Alli M Straubhar et al. Gynecol Oncol. 2020 Sep.

Abstract

Objective: To describe outcomes using a multimodal algorithm to triage patients with advanced epithelial ovarian cancer (EOC) to primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT).

Methods: All patients with EOC treated at our institution from 04/2015-08/2018 were identified. We included patients without contraindication to PDS who underwent prospective calculation of a Resectability (R)-score. A low risk score for suboptimal cytoreduction was defined as ≤6, and a high risk score ≥7. Patients were triaged to laparotomy/PDS, laparoscopic evaluation of resectability (LSC), or NACT depending on R-score.

Results: Among 299 participants, 226 (76%) had a low risk score and 73 (24%) a high risk score. For patients with a low risk score, management included laparotomy/PDS, 181 (80%); LSC, 43 (19%) (with subsequent triage: PDS, 31; NACT, 12); and NACT, 2 (1%). For patients with a high risk score, management included laparotomy/PDS, 9 (12%); LSC, 51 (70%) (with subsequent triage: PDS, 28; NACT, 23); and NACT, 13 (18%). Overall, 83% underwent PDS, with a 75% CGR rate and 94% optimal cytoreduction rate. Use of the algorithm resulted in a 31% LSC rate and a 6% rate of suboptimal PDS.

Conclusions: The multimodal algorithm led to excellent surgical results; 94% of patients achieved an optimal resection, with a very low rate of suboptimal cytoreduction.

Keywords: Cytoreductive outcomes; Neoadjuvant chemotherapy; Ovarian cancer; Primary debulking surgery; Resectability score; Triage algorithm.

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Conflict of interest statement

Declaration of competing interest Outside the submitted work, Dr. Straubhar has a patent W02019195097A1 perineal heating device issued. Dr. Lakhman is a shareholder of Y-mAbs Therapeutics, Inc. Dr. Abu-Rustum reports grants from Stryker/Novadaq, Olympus, and GRAIL. Dr. Chi reports personal fees from Bovie Medical Co. (now Apyx Medical), Verthermia Inc., C Surgeries, and Biom Up, as well as other from Intuitive Surgical, Inc. and TransEnterix, Inc.

Figures

Figure 1.
Figure 1.. Preoperative Algorithm
(EOC, epithelial ovarian cancer; CT, computed tomography; PDS, primary debulking surgery; Dx LSC, diagnostic laparoscopy; NACT, neoadjuvant chemotherapy)
Figure 2.
Figure 2.. Algorithm Adherence and Outcomes Based Upon RS1 Model
(CT, computed tomography; PDS, primary debulking surgery; LSC, diagnostic laparoscopy; NACT, neoadjuvant chemotherapy; CGR, complete gross resection; O, optimal resection; SO, suboptimal resection)
See this image and copyright information in PMC

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