Niina Norppa

Implementation of extensive cytoreductive surgery protocol in advanced epithelial ovarian cancer: Real‐world data on surgical treatment distribution and survival of the whole patient cohort; a single center experience

AbstractIntroductionThe aim was to assess the effect of the implementation of maximal surgical cytoreduction on the treatment decisions and overall survival of the entire patient cohort with advanced epithelial ovarian cancer.Material and MethodsWe collected retrospectively all newly diagnosed patients with FIGO stage IIIB–IVB epithelial ovarian cancer between 2013 and 2019 in Tampere University Hospital, Finland. Altogether, 333 patients were divided into two groups based on the date of diagnosis: Group 1 (n = 162) diagnosed before March 2016 and Group 2 (n = 171) after 1st of March 2016, when a systematic change in surgical approach toward maximal surgical cytoreduction was implemented in our institution.ResultsNo statistically significant differences were found in the proportions of patients having surgery or treated non‐surgically between the two time periods: 76.5% of patients in Group 1 and 71.9% in Group 2 underwent surgical treatment, while the others were treated with chemotherapy only or referred directly to palliative care (p = 0.38). In addition, there was no statistically significant difference in overall survival in patients who received any treatment (surgery and chemotherapy or chemotherapy only) between groups: the median overall survival was 32.8 months (95% CI 25.1–40.5) in Group 1 and 37.3 months (31.5–43.1) in Group 2, p = 0.214.ConclusionsThe change in surgical approach toward maximal surgical cytoreduction in advanced epithelial ovarian cancer did not significantly change the magnitude of patients who received only chemotherapy or underwent surgical treatment in our center. While the shift in surgical paradigm may provide survival benefits for carefully selected surgically treated patients, it did not result in a statistically significant improvement in overall survival for the entire patient cohort.

Maximal surgical effort increases the risk of postoperative complications in the treatment of advanced ovarian cancer

Surgery is the cornerstone of the treatment for advanced ovarian cancer. Reaching complete cytoreduction resulting in no gross residual disease often requires complex surgery. The aim of this study was to assess the impact of increased surgical radicality on the risk of complications in the treatment of advanced ovarian cancer. All consecutive patients with advanced ovarian cancer (FIGO Stage IIIB-IVB) who had undergone primary or interval debulking surgery during a six-year study period were identified. In the midst of the study period, a surgical practice change towards maximal surgical effort occurred. Two groups were formed for the analysis: cohort A, that consisted of patients operated before the surgical paradigm shift and cohort B, that consisted of patients operated under the period of increased surgical radicality. 252 patients were included in the analysis. Complete resection (R0) was achieved in 21.3% of surgeries in cohort A and in 51.2% in cohort B. The total postoperative complication rate was 76.2%. Most of the complications (86.5%) were minor (Clavien-Dindo I-IIIA). The patients in cohort B were at increased risk for complications, OR 2.94 (95%CI 1.58-5.47; p = 0.001). As for the approach to cytoreduction (primary vs. interval debulking), there was no statistically significant association with the occurrence of postoperative complications (p = 0.659). In the present study more extensive surgeries led to better surgical results but increased postoperative morbidity. Postoperative complication rates were similar in both primary and interval debulking surgeries.