Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations

Fabien Vidal, Haya Al Thani, Pascale Haddad, Mathieu Luyckx, Eberhard Stoeckle, Philippe Morice, Eric Leblanc, Fabrice Lecuru, Emile Daraï, Jean Marc Classe, Christophe Pomel, Ziyad Mahfoud, Gwenael Ferron, Denis Querleu, Arash Rafii Tabrizi

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Abstract

Background: In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. Methods: Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. Results: Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10−3). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. Conclusions: In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.

Original languageEnglish
Pages (from-to)434-442
Number of pages9
JournalAnnals of Surgical Oncology
Volume23
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016

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Carcinoma
Survival
Ovarian Neoplasms
Disease-Free Survival
Appointments and Schedules
Retrospective Studies
Morbidity
Recurrence
Population
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis : Beyond Gross Residual Disease Considerations. / Vidal, Fabien; Al Thani, Haya; Haddad, Pascale; Luyckx, Mathieu; Stoeckle, Eberhard; Morice, Philippe; Leblanc, Eric; Lecuru, Fabrice; Daraï, Emile; Classe, Jean Marc; Pomel, Christophe; Mahfoud, Ziyad; Ferron, Gwenael; Querleu, Denis; Tabrizi, Arash Rafii.

In: Annals of Surgical Oncology, Vol. 23, No. 2, 01.02.2016, p. 434-442.

Research output: Contribution to journalArticle

Vidal, F, Al Thani, H, Haddad, P, Luyckx, M, Stoeckle, E, Morice, P, Leblanc, E, Lecuru, F, Daraï, E, Classe, JM, Pomel, C, Mahfoud, Z, Ferron, G, Querleu, D & Tabrizi, AR 2016, 'Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations', Annals of Surgical Oncology, vol. 23, no. 2, pp. 434-442. https://doi.org/10.1245/s10434-015-4890-8
Vidal, Fabien ; Al Thani, Haya ; Haddad, Pascale ; Luyckx, Mathieu ; Stoeckle, Eberhard ; Morice, Philippe ; Leblanc, Eric ; Lecuru, Fabrice ; Daraï, Emile ; Classe, Jean Marc ; Pomel, Christophe ; Mahfoud, Ziyad ; Ferron, Gwenael ; Querleu, Denis ; Tabrizi, Arash Rafii. / Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis : Beyond Gross Residual Disease Considerations. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 2. pp. 434-442.
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abstract = "Background: In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. Methods: Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. Results: Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10−3). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. Conclusions: In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.",
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T1 - Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis

T2 - Beyond Gross Residual Disease Considerations

AU - Vidal, Fabien

AU - Al Thani, Haya

AU - Haddad, Pascale

AU - Luyckx, Mathieu

AU - Stoeckle, Eberhard

AU - Morice, Philippe

AU - Leblanc, Eric

AU - Lecuru, Fabrice

AU - Daraï, Emile

AU - Classe, Jean Marc

AU - Pomel, Christophe

AU - Mahfoud, Ziyad

AU - Ferron, Gwenael

AU - Querleu, Denis

AU - Tabrizi, Arash Rafii

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background: In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. Methods: Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. Results: Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10−3). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. Conclusions: In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.

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