A radical approach to achieve complete cytoreductive surgery improve survival of patients with advanced ovarian cancer

• Published in: Journal of visceral surgery Vol. 157; no. 2; pp. 79 - 86
• Main Authors: Liberale, G., Pop, C.-F., Polastro, L., Kerger, J., Moreau, M., Chintinne, M., Larsimont, D., Nogaret, J.M., Veys, I.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-04-2020
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma - mortality; Carcinoma - pathology; Carcinoma - secondary; Carcinoma - surgery; Conservative Treatment; Cytoreduction Surgical Procedures - methods; Cytoreductive surgery; Female; Humans; Macroscopic residual disease; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Neoplasm, Residual; Ovarian cancer; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Peritoneal carcinomatosis; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - surgery; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Retrospective Studies; Survival Analysis; Treatment Outcome; LN; OS; Cytoreductive surgery; FIGO; Ovarian cancer; AUC; ASA; RA; CS; DFS; NAC; PC; HIPEC; OC; Macroscopic residual disease; AOC; Peritoneal carcinomatosis; PCI; PFS; CA; BMI
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2019.12.002

Cytoreductive surgery of locally advanced ovarian cancer has evolved in the last few years from surgery to remove macroscopic residual disease (<1cm; R2b) to macroscopic complete cytoreductive surgery with no gross residual disease (R1). The aim of this study was to evaluate the impact of the adoption of a maximalist surgical approach on postoperative complications, disease recurrence and survival.
This was a retrospective study using prospectively collected data on patients who received either conservative approach (CA) or radical approach (RA) surgical treatment for primary ovarian cancer stage IIIc/IVa/IVb between June 2006 and June 2013.
Data for 114 patients were included, 33 patients in the CA group and 68 patients in the RA group were consequently analysed. In the RA group, operative time was longer, in relation to more complex surgical procedures; with more blood losses and a higher rate of compete macroscopic resection. Totally, 77% of the patients had postoperative complications, with more grade I/II complications in the RA group but the same rates of grade III/IV complications in the both groups (P=0.14). For all patient study population, the overall and disease-free survivals were improved in case of no macroscopic residual disease. Overall survival was improved in the RA group (P=0.05), with no difference in terms of disease-free survival (P=0.29)
A radical approach in advanced ovarian cancer allows a higher rate of complete cytoreductive surgery impacting overall survival. However, a non-significant trend for increased mild complications (grade I/II) rate is observed in this group.