open access: Upper abdominal cytoreduction and thoracoscopy for advanced epithelial ovarian cancer: unanswered questions and the impact on treatment - 75 patient study

	Positive thoracoscopy	Negative thoracoscopy
GOG, Gynecologic Oncology Group.
n (%)	27 (36.0)	48 (64.0)
Median (range) age, years	60.5 (29–75)	63 (39–76)
GOG Performance Status (0,1)	100%	100%
Location of largest disease
Diaphragm	2/27 (7.4%)	1/48 (2.1%)
Omentum	7/27 (25.9%)	10/48 (20.8%)
Pelvis	15/27 (55.6%)	37/48 (77.1%)
Lymph nodes	2/27 (7.4%)	1/48 (2.1%)
Mesentery	2/27 (7.4%)	1/48 (2.1%)

Table 2.  Surgical Procedures

Table 3.   Morbidity and mortality (Positive/Negative thoracoscopy - complications)

Conclusions

Epithelial ovarian cancer is most commonly diagnosed in advanced stages. The prognostic value of complete cytoreduction has been reported and confirmed in several publications.^6,21,22 Similarly intraperitoneal chemotherapy is associated with improved overall survival in women with small-volume residual disease (<1 cm) and, as with cytoreductive surgery, carries with it increased morbidity.

It is therefore mandatory to do all that is necessary to identify disease that cannot be resected before undertaking a maximal cytoreductive effort for disease that will not benefit from the use of intraperitoneal chemotherapy.

Using the surgical approach described allows both of these goals to be met, thereby maximising the potential benefit to women with advanced-stage epithelial ovarian cancer.