Gynecologic Oncology - Outcome of immediate re-operation or interval debulking after chemotherapy at a gynecologic oncology center after initially incomplete cytoreduction of advanced ovarian cancer
Background
Prognosis
in advanced ovarian cancer is largely determined by completeness of
tumor resection achieved during primary surgery. Incomplete initial
debulking occurs frequently in non-specialized centers and there is an
ongoing discussion about the best time for re-surgery after referral to
tertiary centers.
Methods
Patients
with advanced epithelial ovarian cancer (FIGO IIIB-IV) admitted between
1999 and 2007 who had primary incomplete surgery including those with
initiated chemotherapy at outside institution were included. Surgical
results, morbidity and prognosis were evaluated in patients with
immediate re-operation before chemotherapy and those with interval
debulking.
Results
48
eligible patients were identified in our tumor registry. Self-referral
by patient was the most frequent mode of admission (n = 21, 43.8%). 22
patients (45.8%) patients underwent immediate re-surgery and 26 patients
(54.2%) had an interval debulking after chemotherapy. In 12 patients
(54.5%), macroscopically complete tumor removal could be achieved by
immediate re-operation and in 17 patients (65.4%) after chemotherapy.
Major complications were observed more frequently in patients with
interval debulking (26.9 vs. 9.1%, p = 0.324). Median overall survival
time was 53 and 34 months (p = 0.110) after immediate and delayed
re-operation, respectively.
Conclusions
Upfront
re-operation before start of chemotherapy is feasible and successful in
an expertise referral centre in more than half of patients with
incomplete primary surgery elsewhere. Complete resection even after
initial incomplete debulking could improve outcome. Therefore, referral
to expertise centers in those patients should be considered.
Progression-free survival and overall survival showed a non-significant
trend and complication rate a remarkable advantage in favor of upfront
re-operation.
Keywords
- primary ovarian cancer;
- cytoreductive surgery;
- interval debulking surgery
