Background
Methods
Patients
Definitions
Statistical analysis
Results
Baseline and patient characteristics
Characteristic | Radical surgery group | Standard surgery group | P value* |
---|---|---|---|
Median age (range) | 56 years (35–82) | 56 years (26–79) | 1.000 |
FIGO stage | 0.045 | ||
Stage IIIC | 91(81.2 %) | 215(89.2 %) | |
Stage IV | 21(18.8 %)b | 26(10.8 %) | |
Primary tumor | 0.535 | ||
Epithelial ovarian cancer | 111 (99.1 %) | 240 (99.6 %) | |
Fallopian tube cancer | 1 (0.9 %) | 0 (0 %) | |
Primary peritoneal cancer | 0 (0 %) | 1 (0.4 %) | |
Histology | 0.084 | ||
Serous | 100(89.3 %) | 202(83.8 %) | |
Mucinous | 0(0 %) | 2(0.8 %) | |
Endometrioid | 2(1.8 %) | 2(0.8 %) | |
Clear cell | 2(1.8 %) | 5(2.1 %) | |
Others | 8(7.2 %) | 30(12.4 %) | |
Grade | 0.787 | ||
Grade1 | 0(0 %) | 2(0.8 %) | |
Grade 2 | 9(8.0 %) | 16(6.6 %) | |
Grade 3 | 102(91.1 %) | 218(90.5 %) | |
NA | 1(0.9 %) | 5(2.1 %) | |
ECOG performance status | 0.116 | ||
0 | 57(50.9 %) | 95(39.4 %) | |
1 | 49(43.8 %) | 126(52.3 %) | |
2 | 6(5.4 %) | 20(8.3 %) | |
ASA status | 0.358 | ||
1 | 59(52.7 %) | 107(44.4 %) | |
2 | 51(45.5 %) | 127(52.7 %) | |
3 | 2(1.8 %) | 7(2.9 %) | |
Preoperative serum CA125 | 0.245 | ||
Median serum level (range) | 1320 U/ml (67.2–77050) | 1725 U/ml (32.1–39145) | |
Neoadjuvant chemotherapy | 0.421 | ||
Yes | 20 (17.9 %) | 35 (14.5 %) | |
No | 92 (82.1 %) | 206 (85.5 %) | |
Ascites | 0.472 | ||
Median volume (range) | 1350 ml (0–7000) | 1500 ml (0–10000) | |
Bowel mesenteric carcinomatosis | 0.544 | ||
Yes | 78 (69.6 %) | 160 (66.4 %) | |
No | 34 (30.4 %) | 81 (33.6 %) | |
Residual disease in pelvis | <0.001 | ||
0 cm | 92(82.1 %) | 129(53.5 %) | |
0.1–0.5 cm | 15(13.4 %) | 71(29.5 %) | |
0.5–1 cm | 3(2.7 %) | 41(17.0 %) | |
>1 cm | 2(1.8 %) | 0(0 %) | |
Residual disease in middle abdomen | <0.001 | ||
0 cm | 60(53.6 %) | 69(28.6 %) | |
0.1–0.5 cm | 40(35.7 %) | 93(38.6 %) | |
0.5–1 cm | 9(8.0 %) | 79(32.8 %) | |
>1 cm | 3(2.7 %) | 0(0 %) | |
Total | 112 | 241 |
Tumor site | Radical surgery group | Standard surgery group | P value* |
---|---|---|---|
Right diaphragm | 29 (76.3 %) | 49 (68.1 %) | 0.364 |
Left diaphragm | 6 (15.8 %) | 19 (26.4 %) | 0.207 |
The surface of liver | 9 (23.7 %) | 12 (16.7 %) | 0.373 |
The surface of spleen | 0 (0 %) | 3 (4.2 %) | 0.202 |
Portahepatis | 7 (18.4 %) | 6 (8.3 %) | 0.119 |
Perisplenicregion | 9 (23.7 %) | 17 (23.6 %) | 0.993 |
Spleen parenchyma | 4 (10.5 %) | 2 (2.8 %) | 0.099 |
Lesser omentum | 10 (26.3 %) | 10 (13.9 %) | 0.108 |
Diaphragmatic lymph node | 24 (64.9 %) | 35 (48.6 %) | 0.107 |
Total | 38 | 72 |
Surgical outcomes
Variable | Radical surgery group (n = 112) | Standard surgery group (n = 241) | P value* |
---|---|---|---|
Residual disease, in overall | <0.001 | ||
0 cm | 46 (41.1 %) | 0 (0 %) | |
0.1–0.5 cm | 46 (41.1 %) | 27 (11.2 %) | |
0.5–1 cm | 15 (13.4 %) | 78 (32.4 %) | |
>1 cm | 5 (4.5 %) | 136 (56.4 %) | |
Residual disease in upper abdomen | <0.001 | ||
0 cm | 76(67.9 %) | 0(0 %) | |
0.1–0.5 cm | 24(21.4 %) | 30(12.4 %) | |
0.5–1 cm | 10(8.9 %) | 75(31.1 %) | |
>1 cm | 2(1.8 %) | 136(56.4 %) | |
Estimated blood loss | <0.001 | ||
Median volume | 800 ml | 600 ml | |
(range) | (100–4000) | (100–3000) | |
Intraoperative blood transfusion | <0.001 | ||
Median volume | 800 ml | 400 ml | |
(range) | (0–3200) | (0–2400) | |
Operative time | <0.001 | ||
Median | 171 min | 124 min | |
(range) | (75–360) | (51–318) | |
ICU stay | 0.018 | ||
Yes | 28 (25.0 %) | 35 (14.5 %) | |
No | 84 (75.0 %) | 206 (85.5 %) | |
Length of hospitalization | <0.001 | ||
Mean | 19.96 days | 10.39 days | |
(range) | (4–190)b | (4–42) |
Procedure | No. of patients | Percent |
---|---|---|
Left side diaphragm peritonectomy | 1 | 0.9 % |
Right side diaphragm peritonectomy | 79 | 70.5 % |
Both sides diaphragm peritonectomy | 20 | 17.9 % |
Full-thickness diaphragm resection | 7 | 6.3 % |
Thoracic exploration | 13 | 11.6 % |
Resection of lesser omentum | 35 | 31.3 % |
Splenectomy | 17 | 15.2 % |
Liver resection | 8 | 7.1 % |
Distal pancreatectomy | 2 | 1.8 % |
Cholecystectomy | 1 | 0.9 % |
Resection of the tumor on the surface of liver | 27 | 24.1 % |
Resection of the tumor on the surface of stomach | 8 | 7.1 % |
Resection of the tumor on the surface of spleen | 5 | 4.5 % |
Resection of the tumor in the gallbladder fossa | 5 | 4.5 % |
Resection of the renal capsule | 1 | 0.9 % |
Procedure | No. of patients | Percent |
---|---|---|
Diaphragm stripping | 4 | 1.7 % |
Diaphragm peritonectomy | 0 | 0 % |
Full-thickness diaphragm resection | 0 | 0 % |
Thoracic exploration | 0 | 0 % |
Resection of lesser omentum | 6 | 2.5 % |
Splenectomy | 8 | 3.3 % |
Liver resection | 0 | 0 % |
Distal pancreatectomy | 1a | 0 % |
Cholecystectomy | 0 | 0 % |
Resection of the tumor on the surface of liver | 3 | 1.2 % |
Resection of the tumor on the surface of stomach | 2 | 0.8 % |
Resection of the tumor on the surface of spleen | 1 | 0.4 % |
Resection of the tumor in the gallbladder fossa | 0 | 0 % |
Resection of the renal capsule | 0 | 0 % |
Years of the data | ||||
---|---|---|---|---|
Groups | 2009.6–2011.6 | 2011.7–2012.12 | ||
Team A | Team B | Team A | Team B | |
Radical surgery group (n = 112) | 29 (65.9 %) | 9 (8.8 %) | 53 (73.6 %) | 21 (15.6 %) |
Standard surgery group (n = 241) | 15 (34.1 %) | 93 (91.2 %) | 19 (26.4 %) | 114 (84.4 %) |
Total | 44 | 102 | 72 | 135 |
Variables | B | S.E, | P value | RR | 95 % C.I. | |
---|---|---|---|---|---|---|
Upper | Lower | |||||
R0
| ||||||
Neoadjuvant chemotherapy | −1.004 | 0.367 | 0.006 | 0.366 | 0.178 | 0.752 |
ASA score | 0.772 | 0.314 | 0.014 | 2.165 | 1.170 | 4.006 |
Bowel mesenteric carcinomatosisc | 0.718 | 0.323 | 0.026 | 2.051 | 1.008 | 3.866 |
R0.5
| ||||||
Neoadjuvant chemotherapy | −0.907 | 0.301 | 0.003 | 0.404 | 0.224 | 0.729 |
ECOG performance | 0.639 | 0.190 | 0.001 | 1.895 | 1.307 | 2.747 |
Complications | EUAS group (n = 112) | Non- EUAS group (n = 241) |
---|---|---|
Thoracentesis/chest tube placement | 9(8.0 %) | 4(1.7 %) |
Pulmonaryembolism | 1(0.9 %) | 1(0.4 %) |
Deep venous thrombosis | 1(0.9 %) | 0 |
Cerebral infarction | 0 | 1(0.4 %) |
Bowel obstruction | 2(1.8 %) | 8(3.3 %) |
Wound infection | 2(1.8 %) | 2(0.8 %) |
Abdominalinfections | 1(0.9 %) | 13(5.4 %) |
Pneumonia | 1(0.9 %) | 1(0.4 %) |
Urinary tract infection | 0 | 1(0.4 %) |
Gastroenteritis | 1(0.9 %) | 0 |
Heart failure/arrhythmia | 1(0.9 %) | 0 |
Relaparotomy for hemorrhage | 1(0.9 %) | 1 (0.4 %) |
Blood transfusion for hemorrhage | 0 | 2(0.8 %) |
Median PRBC | 0 | 8u/4ua |
Intestinal fistula | 0 | 1(0.4 %) |
MSKCC Grade III/IVb | 9 (8.0 %) | 7 (2.9 %) |
Mortality (MSKCC Grade V) | 0 | 1(0.4 %) |
Complications | Team A (n = 116) | Team B (n = 237) |
---|---|---|
Thoracentesis/chest tube placement | 6(5.2 %) | 7(3.0 %) |
Pulmonaryembolism | 1(0.9 %) | 1(0.4 %) |
Deep venous thrombosis | 0 | 1(0.4 %) |
Cerebral infarction | 1(0.9 %) | 0 |
Bowel obstruction | 0(0.9 %) | 10(4.2 %) |
Wound infection | 1(0.9 %) | 3(1.3 %) |
Abdominal infections | 4(3.4 %) | 10(4.2 %) |
Pneumonia | 0 | 2(0.8 %) |
Urinary tract infection | 0 | 1(0.4 %) |
Gastroenteritis | 1(0.9 %) | 0 |
Heart failure/arrhythmia | 1(0.9 %) | 0 |
Relaparotomy for hemorrhage | 0(0.0 %) | 2 (0.8 %) |
Blood transfusion for hemorrhage | 0 | 2(0.8 %) |
Intestinal fistula | 0 | 1(0.4 %) |
MSKCC Grade III/IV | 7 (6.0 %) | 9 (3.8 %) |
Mortality (MSKCC Grade V) | 0 | 1(0.4 %) |
Survival predictors
Characteristic | N | Median PFS | Univariate | Multivariate | |
---|---|---|---|---|---|
(months) | P value | HR (95 %CI) | P value | ||
FIGO stage | 0.004 | 1.62 (1.16–2.27) | 0.001 | ||
IIIC | 305 | 15.3 | |||
IV | 46 | 11.4 | |||
Residual disease in upper abdomen | <0.001 | 1.29 (1.16–1.44) | 0.002 | ||
0 cm | 75 | 23.3 | |||
0–0.5 cm | 54 | 17.8 | |||
0.5–1 cm | 85 | 13.5 | |||
>1 cm | 137 | 12.6 | |||
Total | 351 | 14.7 |
Discussion
The role of radical surgery with an additional upper abdominal cytoreduction
“Maximal” cytoreduction and residual disease in bulky ovarian cancer
Tumor site | N | B | SE | P value* | RR | 95 % CI |
---|---|---|---|---|---|---|
Residual disease, in overall | 1.466 | 0.453 | 0.001 | 4.333 | 0.639–6.379 | |
Micro- | 14 | |||||
Macro- | 96 | |||||
Residual disease in upper abdomen | 1.099 | 0.408 | 0.007 | 3.000 | 0.526–3.724 | |
Micro- | 23 | |||||
Macro- | 87 | |||||
Total | 110 |