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abstract
Introduction
Patients
referred with inadequately staged ovarian malignancies present a
clinical dilemma. We report our experience with completion surgery in
ovarian cancer.
Aims and Objectives
To determine the benefits and risks of completion surgery in women with
ovarian cancer who presented after having had inadequate primary
surgery.
Methods
A retrospective case series of 30 women with ovarian cancer and one with
fallopian tube cancer who had inadequate primary surgery underwent
completion surgery at gynaecologic oncology unit in a tertiary level
hospital in Tamil Nadu, India. Electronic medical records of patients
with ovarian cancer who underwent completion surgery between January
2011 and September 2014 for ovarian were reviewed. Forty-five patients
with initial inadequate surgery were identified of whom 31 underwent
completion surgery; the remaining 14 did not return to our hospital.
Results
Thirty-one
women with a mean age of 37 years (17–53) and median parity of 2 (0–4)
with inadequately staged ovarian malignancy underwent completion
surgery. Complex ovarian mass was the most common indication for initial
surgery (94 %). The tumours were epithelial in 27 (87 %), germ cell in 3
(10 %) and sex cord stromal in 1 (3 %). In view of extensive disease at
presentation, 19 % (6/31) were referred for neoadjuvant chemotherapy
and underwent interval debulking. With regard to surgical complexity,
52 % (16/31), 38 % (12/31) and 10 % (3/31) underwent simple,
intermediate and complex surgeries, respectively. Optimal cytoreduction
(R0 and R1) was performed in 25 patients (81 %). Twelve (39 %) had
upstaging of disease. Six patients required no further adjuvant
treatment following surgical restaging. Complications included bladder
injury (1), iliac vessel injury (1) and surgical site infections (2).
During the study period of 45 months, 7 patients (23 %) presented with
disease recurrence. There were 2 recorded deaths.
Conclusions
In
inadequately staged ovarian malignancies, completion surgery should be
considered based on the patients’ performance status and disease
assessment. Considering the low specificity of imaging and Ca 125,
completion surgery provides information to plan adjuvant therapy,
besides allowing optimal cytoreduction but delays initiation of adjuvant
therapy
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