Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in:

10.01.2021 | Gynecologic Oncology

Multidisciplinary Surgical Approach to Increase Complete Cytoreduction Rates for Advanced Ovarian Cancer in a Tertiary Gynecologic Oncology Center

verfasst von: Karen M. Mulligan, MA Genetics, MD, Kate Glennon, MD, MRCPI, Fionán Donohoe, MD, MRCPI, MRCOG, Yvonne O’Brien, MD, MRCPI, MRCOG, Brian C. Mc Donnell, MD, Helena C. Bartels, MD, MRCPI, Carolien Vermeulen, MB, BCh, Tom Walsh, MD, MRCPI, MRCOG, Conor Shields, BSc, MD, FRCSI, Orla McCormack, MD, FRCSI, John Conneely, MD, BSc, MCh, FRCSI (Gen), William D. Boyd, MD, MRCOG, FRC, ONC, CAN, Ruaidhrí Mc Vey, LRCP&SI (Hons), MRCSI, MRCPI, MRCOG, MD, MCE, MSc, Jurgen Mulsow, MB, MD, FRCSI, Donal J. Brennan, MD, MRCPI, MRCOG, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit.

Methods

The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A).

Results

This study included 146 patients in cohort A (2006–2015) and 93 patients in cohort B (2017–2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006–2019).

Conclusions

The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.CrossRef
2.
du Bois A, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115:1234–44.CrossRef
3.
Van der Burg ME, van Lent M, Buyse M, Kobierska A, Colombo N, Favalli G, et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J. 1995;332(10):629–34.CrossRef
4.
Aletti G, Dowdy SC, Podratz KC, Cliby WA. Analysis of factors impacting operability in stage IV ovarian cancer: rationale use of a triage system. Gynecol Oncol. 2007;105:84–9.CrossRef
5.
Al Rawahi T, Lopes AD, Bristow RE, Bryant A, Elattar A, Chattopadhyay S, et al. Surgical cytoreduction for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev. 2013:Cd008765.
6.
Van Driel WJ, Koole SN, Sikorska K, Schagen van Leeuwen JH, Schreuder HWR, Hermans RHM, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378:230–40.
7.
Bartels HC, Rogers AC, McSharry V, McVey R, Walsh T, O’Brien D, et al. A meta-analysis of morbidity and mortality in primary cytoreductive surgery compared to neoadjuvant chemotherapy in advanced ovarian malignancy. Gynecol Oncol. 2019;154:622–30.CrossRef
8.
9.
Vermeulen C, Walsh T, Kruitwagen R, Tadesse W. Multi-disciplinary assessment proves to be effective in detecting suitable patients for primary debulking surgery in advanced stage epithelial ovarian cancer 2015.
10.
Chang KH, Kazanowski M, Staunton O, Cahill RA, Moran BJ, Shields C, Mulsow J. Mentored experience of establishing a national peritoneal malignancy programme: experience of first 50 operative cases. EJSO Eur J Surg Oncol. 2017;43:395–400.CrossRef
11.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef
12.
Esquivel J, Sugarbaker PH, Helm CW (2007) Techniques of delivering hyperthermic intraperitoneal chemotherapy. In: Helm CW, Edwards RP, editors. Intraperitoneal cancer therapy: current clinical oncology. Totowa, NJ: Humana Press; 2007.
13.
Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO. Centralisation of services for gynaecological cancers: a Cochrane systematic review. Gynecol Oncol. 2012;126:286–90.CrossRef
14.
Vernooij F, Heintz AP, Coebergh JW, Massuger LF, Witteveen PO, van der Graaf Y. Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands. Gynecol Oncol. 2009;112:455–61.CrossRef
15.
Tingulstad S, Skjeldestad FE, Hagen B. The effect of centralization of primary surgery on survival in ovarian cancer patients. Obstet Gynecol. 2003;102:499–505.PubMed
16.
Sinno AK, Li X, Thompson RE, Tanner EJ III, Levinson KL, Stone RL, et al. Trends and factors associated with radical cytoreductive surgery in the United States: a case for centralized care. Gynecol Oncol. 2017;145:493–9.CrossRef
17.
18.
Rausei S, Uccella S, D’Alessandro V, Gisone B, Frattini F, Lianos G. Aggressive surgery for advanced ovarian cancer performed by a multidisciplinary team: a retrospective analysis on a large series of patients. Surg Open Sci. 2019;1:43–7.CrossRef
19.
Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithelial ovarian cancer Cochrane Database Syst Rev. 2011;10:1–67.
20.
21.
Kehoe S, Hook J, Nankivell M, Jayson G, Kitchener H, Lopes A, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386(9990):249–57.CrossRef
Metadaten
Titel
Multidisciplinary Surgical Approach to Increase Complete Cytoreduction Rates for Advanced Ovarian Cancer in a Tertiary Gynecologic Oncology Center
verfasst von
Karen M. Mulligan, MA Genetics, MD
Kate Glennon, MD, MRCPI
Fionán Donohoe, MD, MRCPI, MRCOG
Yvonne O’Brien, MD, MRCPI, MRCOG
Brian C. Mc Donnell, MD
Helena C. Bartels, MD, MRCPI
Carolien Vermeulen, MB, BCh
Tom Walsh, MD, MRCPI, MRCOG
Conor Shields, BSc, MD, FRCSI
Orla McCormack, MD, FRCSI
John Conneely, MD, BSc, MCh, FRCSI (Gen)
William D. Boyd, MD, MRCOG, FRC, ONC, CAN
Ruaidhrí Mc Vey, LRCP&SI (Hons), MRCSI, MRCPI, MRCOG, MD, MCE, MSc
Jurgen Mulsow, MB, MD, FRCSI
Donal J. Brennan, MD, MRCPI, MRCOG, PhD
Publikationsdatum
10.01.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09494-3

Weitere Artikel der Ausgabe 8/2021

Pulmonary Metastasectomy in Patients with Lung Metastases from Nasopharyngeal Carcinoma

  • Thoracic Oncology

ASO Author Reflections: The Multidisciplinary Approach to de Novo Metastatic Inflammatory Breast Cancer: A Combined Systemic and Locoregional Strategy

  • ASO Author Reflections

ASO Visual Abstract: The Landmark Series—Minimally Invasive Pancreatic Resection

  • ASO Visual Abstract

ASO Author Reflections: Circulating Tumor DNA (ctDNA) as a Potentially Practice-Changing Innovation to Evolve “Precision Onco-Surgery” in Resectable Colorectal Liver Metastases

  • ASO Author Reflections

ASO Author Reflections: Gastrectomy Within 30 Days After Neoadjuvant Chemotherapy is Associated with the Highest Rate of Major Pathologic Response in Advanced Gastric Cancer

  • ASO Author Reflections

ASO Author Reflections: Will Breast Cancer Screening Become Personalized?

  • ASO Author Reflections

Neu im Fachgebiet Chirurgie

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Mit Lidocain kommt der Darm nicht schneller in Schwung

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise