Transactions of the 67th Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists
Predictors of suboptimal surgical cytoreduction in women treated with initial cytoreductive surgery for advanced stage epithelial ovarian cancer

https://doi.org/10.1016/j.ajog.2005.03.058Get rights and content

Objective

The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer.

Study design

All women with stage III/IV epithelial ovarian cancer treated with initial surgery at our hospital between January 1, 1995 and January 1, 2003 were eligible; 56 patients met inclusion criteria and underwent retrospective chart review. Statistical analysis was performed using SPSS.

Results

Twenty-nine women (52%) had optimal cytoreduction (OC), and 27 (48%) had suboptimal cytoreduction (SC). Women in the SC group had higher median CA-125 values at surgery (954 SC vs 597 OC, P = .07). Three sites of disease on preoperative CT were reported more frequently in the SC patients; omentum (P = .007), parietal peritoneum (P = .096), and ascites (P = .093).

Conclusion

A suboptimal cytoreduction confers no survival advantage to women with advanced ovarian cancer. Thus, these patients may be the best candidates for initial chemotherapy, and identifying them preoperatively becomes important.

Section snippets

Material and methods

The Human Investigations Committee at the University of Virginia approved this study. The Tumor Registry provided a list of all patients who underwent surgery at our institution for FIGO stage III or IV epithelial ovarian cancer between January 1, 1995 to January 1, 2003. Two hundred fifty-two patients were identified. Seven patients were excluded for incomplete medical records, 6 patients for stage I or II disease, 26 patients for surgery at another institution, and 13 patients for receiving

Results

Pathologic data is shown in Table I. Optimal cytoreduction was achieved in 29 women (52%), and 27 women (48%) had suboptimal surgical cytoreduction. Mean age for the entire population was 64 years (range 38 to 86). Forty-five patients (80%) had serous histology, 93% had stage III disease, and 67% had grade 3 disease. The 1 patient with stage IIIA disease had an optimal result. The 3 stage IIIB patients with suboptimal results all had disease at the diaphragm. There was no difference between the

Comment

Ovarian carcinoma is the leading cause of morbidity and mortality from gynecologic malignancies in the US. Contemporary surgical treatment for advanced stage epithelial ovarian cancer includes optimal surgical cytoreduction of tumor to <1 cm. However, at the time of diagnosis, approximately two thirds of women have advanced stage III or IV disease and, despite advances in surgical technique, this extensive tumor volume and distribution make the achievement of an optimal surgical cytoreduction

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    Presented at the Sixty-Seventh Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, January 22-25, 2005, White Sulphur Springs, WVa.

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