ADVANCED EPITHELIAL OVARIAN CANCER: THE PROGNOSTIC SIGNIFICANCE OF RESIDUAL DISEASE AFTER CYTOREDUCTIVE SURGERY

Document Type : Original Article

Authors

1 Departments of General Surgery, Faculty of Medicine, Minoufiya University

2 Gynecology and Obstetrics, Faculty of Medicine, Minoufiya University

3 Department of General Surgery, Faculty of Medicine, Menya University

4 Nuclear Medicine, Faculty of Medicine, Minoufiya University

Abstract

Surgery remains the cornerstone of the treatment for epithelial ovarian cancer. For patients with advanced disease, the 
initial cytoreductive operation reduces tumor bulk and produces increased sensitivity to chemotherapy for the remaining 
tumor. The purpose of our study is to report the benefit of cytoreductive surgery by comparing patients with optimal residual disease ≤ 2cm, with those with suboptimal residual tumor >2cm. To assess the risk of operative complications and to identify determinants of survival. 
Patients and Methods: Between January 1998 and March 2002, 37 patients with FIGO stage II-IV underwent cytoreductive surgery followed by postoperative adjuvant cisplatin-based chemotherapy. A second-look laparotomy was performed in 15 patients (40.5%). The median follow-up was 18 months (range, 7-54). 
Results: Optimal cytoreduction to ≤ 2cm tumor deposits was performed in 16 cases (43.2%) and suboptimal cytoreduction to > 2cm residual tumors was performed in 21 cases (56.8%). The majority of patients had stage III disease (56.8%), serous epithelial ovarian cancer (67.6%), and moderately differentiated tumors (67.6%). Lymph nodes were positive in 15 cases (40.5%). Sixteen patients (43.2%) had positive cytology for ascites. CA-125 serum level was raised pre-operatively in 29 cases (78.4%). Postoperative complications occurred in 17 patients (45.9%). In our study population, advanced FIGO stage and high grade tumors acted as high-risk biologic markers in predicting suboptimal debulking. The overall median survival was 29 months, with overall 3-year survival of 40%. By multivariate analysis, only advanced FIGO stage, positive lymph nodes, and residual tumor deposits > 2cm remained significant for poor survival. 
Conclusion: Optimal cytoreduction in women with advanced epithelial ovarian cancer is associated with a more favorable outcome survival.

Keywords

The Egyptian Journal of Surgery
Volume 21, Issue 4
October 2002
Pages 1032-1042

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