Can complete tumor resection be predicted in advanced primary epithelial ovarian cancer? A systematic evaluation of 360 consecutive patients

被引:38
作者
Fotopoulou, C. [1 ]
Richter, R. [1 ]
Braicu, E. I. [1 ]
Schmidt, S. -C. [2 ]
Lichtenegger, W. [1 ]
Sehouli, J. [1 ]
机构
[1] Univ Hosp, Dept Gynecol, Charite, Campus Virchow Clin, D-13353 Berlin, Germany
[2] Univ Hosp, Dept Gen Visceral & Transplantat Surg, Charite, Campus Virchow Clin, D-13353 Berlin, Germany
来源
EJSO | 2010年 / 36卷 / 12期
关键词
Ovarian cancer; Cytoreductive surgery; Optimal tumor debulking; Predictive factors; Tumor residuals; SUBOPTIMAL CYTOREDUCTIVE SURGERY; PREOPERATIVE SERUM CA-125; SURGICAL CYTOREDUCTION; NEOADJUVANT CHEMOTHERAPY; RECTOSIGMOID RESECTION; PERITONEAL CANCER; PRESURGICAL CA125; FALLOPIAN-TUBE; RISK-FACTORS; UTILITY;
D O I
10.1016/j.ejso.2010.09.008
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Postoperative tumor-residual-mass is the most important prognostic factor in epithelial ovarian cancer (EOC). Aim of our study was to define risk factors for incomplete tumor resection in advanced primary EOC. Patients & methods: A validated intraoperative documentation tool ("Intraoperative-Mapping of Ovarian-Cancer" = "IMO") was applied to systematically evaluate intraabdominal tumor dissemination pattern, maximal tumor load, tumor residuals and operative morbidity for all EOC-patients who underwent primary surgery in our institution during 09/2000-08/2009. Univariate- and multivariate analysis were performed to identify independent risk factors of incomplete tumor resection and operative complications. Results: We evaluated 360 consecutive EOC-patients of FIGO-stage-III/IV. In 221(61%) patients a complete tumor resection could be obtained. In 50(14%) patients tumor residuals were <0.5 cm. Sixty (17%) patients developed a major (14%) complication. Multivariate analysis identified intestinal resection (OR:2.0; 95%CI:1.14-3.4; p = 0.01) and macroscopical tumor residuals (OR:0.5; 95%CI:0.2-1.2; p = 0.05) as independent predictors of major operative morbidity. Tumor dissemination pattern and maximal tumor load were significantly different between tumor-free and not-tumor-free operated patients, with less extrapelvic tumor involvement in the tumor-free group (p < 0.001). More than 4 IMO-fields of tumor involvement (OR:3.3; 95%CI:1.5-7.0; p = 0.002) were identified to be of predictive significance for incomplete tumor resection. FIGO-stage, histology, age, CA 125-levels, bowel resection and ascites did not affect optimal tumor resectability. Conclusions: Tumor expanding in multiple (>4) abdominal quadrants was the major negative predictors for complete tumor resection in primary EOC-patients. Bowel resection and macroscopical tumor residuals were of predictive value for a higher operative major morbidity. Identifying high-risk patients for suboptimal tumor resection and operative complications may improve surgical outcome in advanced primary EOC. (C) 2010 Elsevier Ltd. All rights reserved.
引用
收藏
页码:1202 / 1210
页数:9
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