Splenectomy in the context of primary cytoreductive operations for advanced epithelial ovarian cancer
Introduction
Numerous reports have demonstrated the completeness of primary cytoreductive operations for advanced epithelial ovarian cancer to correlate with the prognosis for survival [1], [2], [3], [4], [5], [6], [7]. However, it has been suggested that a widespread upper abdominal tumor burden reflects “biologically aggressive” disease and that requirement of extensive as opposed to minimal upper abdominal operations to attain a visibly disease-free cytoreductive outcome may diminish or preclude the possibility of long-term survival [8], [9], [10], [11], [12]. Hence, the extent to which the natural history of advanced stage epithelial ovarian cancer can be altered if multiple upper abdominal procedures are necessary to accomplish “optimal” or complete cytoreduction remains somewhat controversial. The need to perform splenectomy in particular has been suggested to reflect a disease that is “biologically aggressive”, and the appropriateness of splenectomy in the context of primary cytoreductive operations has been questioned [11], [12]. In this series, we analyze whether the necessity to perform a splenectomy to achieve complete cytoreduction for stage IIIC epithelial ovarian cancer, due to splenic involvement with metastatic disease, increases morbidity and diminishes the probability of survival.
Section snippets
Methods and materials
Between 1990 and June 2004, 404 patients with stage IIIC epithelial ovarian cancer underwent primary cytoreductive surgery by members of the Encino–Tarzana division of the Woman's Cancer Center, of which 356 (88.1%) were cytoreduced to a visibly disease-free outcome. Of those completely cytoreduced, 49 (13.8%) required a splenectomy to accomplish complete cytoreduction in the context of their procedures. The extent of disease present before cytoreduction, morbidity, and subsequent survival of
Results
Within the cohort, the subgroup requiring a splenectomy was significantly older, had more extensive disease by multiple criteria, and required several procedures with a greater frequency (Table 1). The total operative time, estimated blood loss, units of blood transfused, and hospital stay were greater for patients who had a splenectomy, although an equivalent fraction were treated with chemotherapy before discharge (Table 2). Patients requiring splenectomy had an insignificant trend to more
Discussion
Median and long-term survival for patients with advanced stage epithelial ovarian cancer have been consistently reported to correlate with the completeness of primary cytoreductive surgery [1], [2], [3], [4], [5], [6], [7]. Nevertheless, relative influences of treatment strategy and “innate biological properties” of disease on the prognosis for long-term survival or cure remain somewhat controversial. It has been proposed that “optimal” and complete cytoreduction may be achievable due to
References (38)
- et al.
The prognostic significance of residual disease, FIGO substage, tumor histology, and grade in patients with FIGO stage III ovarian cancer
Gynecol. Oncol.
(1995) - et al.
Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with ovarian cancer. A prospective study
Gynecol. Oncol.
(2003) - et al.
The effect of bowel resection on survival in advanced epithelial ovarian cancer
Gynecol. Oncol.
(2001) A critique of surgical cytoreduction in advanced ovarian cancer
Gynecol. Oncol.
(2000)- et al.
Electrosurgical debulking of ovarian cancer: a new technique using the Argon Beam Coagulator
Gynecol. Oncol.
(1990) The cavitronal ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer
Am. J. Obstet. Gynecol.
(1992)- et al.
Resection of diaphragmatic peritoneum and muscle: role in cytoreductive surgery for ovarian cancer
Gynecol. Oncol.
(1989) - et al.
Loop electrosurgical excision procedure for intensified cytoreduction surgery of ovarian cancer
Gynecol. Oncol.
(1995) - et al.
Cytoreductive surgery in advanced epithelial cancer of the ovary: the impact of aortic and pelvic lymphadenectomy
Gynecol. Oncol.
(1995) - et al.
The clinical significance of occult macroscopically positive retroperitoneal nodes in patients with epithelial ovarian cancer
Gynecol. Oncol.
(2001)
Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized trial
Surgery
Complete cytoreduction: is epithelial ovarian cancer confined to the pelvis biologically different from bulky abdominal disease?
Gynecol. Oncol.
Does debulking surgery improve survival in biologically aggressive ovarian cancer
Gynecol. Oncol.
Procedures required to accomplish complete cytoreduction for ovarian cancer. Is there a correlation with “biological aggressiveness” and survival?
Gynecol. Oncol.
Splenectomy and surgical cytoreduction for ovarian cancer
Gynecol. Oncol.
Splenectomy during primary cytoreductive surgery for ovarian cancer
Gynecol. Oncol.
Splenectomy in recurrent epithelial ovarian cancer
Gynecol. Oncol.
Solitary recurrent metastasis of epithelial ovarian cancer in the spleen
Gynecol. Oncol.
What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer?
Gynecol. Oncol.
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