Abstract
Background
Almost all retrospective trials pointed out that a benefit of surgery for recurrent ovarian cancer may be limited to patients in whom a macroscopic complete resection could be achieved. Peritoneal carcinomatosis has been reported to be either a negative predictor for resectability or a negative prognostic factor, or both. The role of peritoneal carcinomatosis in a multicenter trial was investigated.
Methods
Exploratory analysis of the DESKTOP I trial (multicenter trial of patients undergoing surgery for recurrent ovarian cancer, 2000 to 2003).
Results
A total of 125 patients (50%) who underwent surgery for recurrent ovarian cancer had peritoneal carcinomatosis. Univariate analyses showed worse overall survival for patients with peritoneal carcinomatosis compared with patients without carcinomatosis (P < .0001). Patients with and without peritoneal carcinomatosis had a complete resection rate of 26% and 74%, respectively (P < .0001). This corresponded with the observation that patients with complete resection had a better prognosis than those with minimal residual disease of 1 to 5 mm, which commonly reflects peritoneal carcinomatosis (P = .0002). However, patients who underwent complete resection, despite peritoneal carcinomatosis, had a 2-year survival rate of 77%, which was similar to the 2-year survival rate of patients with completely debulked disease who did not have peritoneal carcinomatosis (81%) (P = .96). Analysis of prognostic factors did not show any independent effect of peritoneal carcinomatosis on survival in patients who underwent complete resection.
Conclusions
Peritoneal carcinomatosis was a negative predictor for complete resection but had no effect on prognosis if complete resection could be achieved. Improving surgical skills might be one step to increase the proportion of patients who might benefit from surgery for recurrent disease.
Similar content being viewed by others
References
Eisenkop SM, Friedman RL, Spirtos NM. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer. 2000;88:144–53.
Gronlund B, Lundvall L, Christensen IJ, et al. Surgical cytoreduction in recurrent ovarian carcinoma in patients with complete reponse to paclitaxel-platinum. Eur J Surg Oncol. 2005;31:67–73.
Jaenicke F, Holscher M, Kuhn W, et al. Radical surgery procedure improves survival time in patients with recurrent ovarian cancer. Cancer. 1992;70:2129–36.
Leitao MM, Kardos S, Barakat RR, Chi DS. Tertiary cytoreduction in patients with recurrent ovarian cancer. Gynecol Oncol. 2004;95:181–5.
Scarabelli C, Gallo A, Carbone A. Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol. 2001;83:504–12.
Tay EH, Grant PT, Gebski V, Hacker NF. Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Obstet Gynecol. 2002;99:1008–13.
Zang RY, Li ZT, Tang J, et al. Secondary cytoreductive surgery for patients with relapsed epithelial ovarian carcinoma: who benefits? Cancer. 2004;100:1152–61.
Benedetti Panici P, De Vivo A, Bellati F, et al. Secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer. Ann Surg Oncol. 2007;14:1136–42.
Harter P, du Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial. Ann Surg Oncol. 2006;13:1702–10.
Chi DS, McCaughty K, Diaz JP, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent platinum-sensitive epithelial ovarian carcinoma. Cancer. 2006;106:1933–9.
Saygili U, Guclu S, Uslu T, Erten O, Dogan E. The effect of ascites, mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with ovarian carcinoma. Int J Gynecol Cancer. 2002;12:438–42.
Sehouli J, Könsgen D, Mustea A, et al. IMO—intraoperative mapping of ovarian cancer. Zentralbl Gynakol. 2003;125:129–35.
Eisenkop SM, Spirtos NM. Procedures required to accomplish complete cytoreduction of ovarian cancer: is there a correlation between “biological aggressiveness” and survival? Gynecol Oncol. 2001;82:435–41.
Eisenkop SM, Spirtos NM. What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer. Gynecol Oncol. 2001;82:489–97.
Harter P, du Bois A. The role of surgery in ovarian cancer with special emphasis on cytoreductive surgery for recurrence. Curr Opin Oncol. 2005;17:505–14.
Parmar MK, Lederman JA, Colombo N, et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet. 2003;361:2099–106.
Pfisterer J, Plante M, Vergote I, et al. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol. 2006;24:4699–707.
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.
Wimberger P, Lehmann N, Kimmig R, et al. Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol. 2007;106:69–74.
du Bois A, Quinn M, Thigpen T, et al. Consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol. 2005;16(Suppl 8):viii7–12.
Winter III WE, Maxwell GL, Tian CT, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2007;25:3621–7.
Onda T, Yoshikawa H, Yasugi T, Yamada M, Matsumoto K, Taketani J. Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection. Br J Cancer. 2005;92:1026–32.
Oksefjell H, Sandstad B, Tropé C. The role of secondary cytoreduction in the management of the first relapse in epithelial ovarian cancer. Ann Oncol (in press) 25 August 2008 (Epub ahead of print).
Eisenkop SM, Spirtos NM, Friedman RL, et al. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 2003;90:390–6.
Ferrandina G, Legge F, Salutari V, et al. Impact of pattern of recurrence on clinical outcome of ovarian cancer patients: clinical considerations. Eur J Cancer. 2006;42:2296–302.
Lorenz R, Krestin GP, Schmitz-Rixen T, Arnold G. The significance of sonography and computed tomography for the diagnosis of the intraperitoneal spread of tumors. Findings in 307 cases of peritoneal carcinosis. Rofo. 1990;152:516–22.
Eisenhauer EL, Abu-Rustum NR, Sonoda Y, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol. 2006;103:1083–90.
Eisenhauer EL, Chi DS. Liver mobilization and diaphragm peritonectomy/resection. Gynecol Oncol. 2007;104(2S1):25–8.
Chi DS, Diaz JP, Jarnagin WR. Distal partial gastrectomy and gastrojejunal anastomosis for recurrent ovarian cancer. Gynecol Oncol. 2007;104(2S1):33–6.
Acknowledgments
Further members of the AGO OVAR and/or AGO Ovarian committee who contributed to this study are: J. Pfisterer (Kiel), K. Wollschlaeger (Magdeburg), H. G. Meerpohl (Karlsruhe), G. P. Breitbach (Neunkirchen), B. Tanner (Berlin), J. Sehouli (Berlin), and V. Heil (Ulm). We thank S. Eichner, A. Krüger, M. Schulze, C. Ackermann, and G. Elser (AGO-OVAR study office) for data management and technical support, and J. Rau, A. Reuss, and C. Schade-Brittinger (KKS Marburg) for statistical support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Harter, P., Hahmann, M., Lueck, H.J. et al. Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis. Ann Surg Oncol 16, 1324–1330 (2009). https://doi.org/10.1245/s10434-009-0357-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0357-0