Sarah Ehmann

Cytoreductive surgery for recurrent platinum-sensitive low-grade ovarian carcinoma: a retrospective single institution experience

Cytoreductive surgery with complete gross resection improves survival in selected patients with recurrent platinum-sensitive epithelial ovarian cancer. Limited data are available on sub-groups with rare histological sub-types undergoing cytoreductive surgery for recurrent disease. We analyzed the outcomes of patients with low-grade histologies undergoing surgery for recurrent disease. We performed a retrospective exploratory database analysis of patients undergoing cytoreductive surgery for recurrent platinum-sensitive low-grade epithelial ovarian cancer at a tertiary cancer center in Germany between 1999 and 2024. In total, 74 patients were included. The majority had low-grade serous histology (53 of 74 [72%]). Median progression-free survival to first recurrence was 34.1 months. The most common surgical procedures were peritonectomy (72%), lymphadenectomy (34%), and large-bowel resection (30%). The stoma rate was 11%. Complete gross resection was achieved in 51 of 74 patients (69%), and 7 patients (9.5%) had residual disease of 1 to 10 mm. The rate of severe complications (Clavien-Dindo grade ≥3) was 12%. In total, 84% of patients received chemotherapy and 11% received endocrine therapy after surgery. Median progression-free survival and overall survival after cytoreductive surgery for recurrence were 26.5 months and 93 months, respectively. On multi-variate analysis, complete gross resection versus residual disease > 10 mm (p = .002) was the only significant factor for overall survival. Cytoreductive surgery for patients with recurrent platinum-sensitive low-grade ovarian cancer appears feasible and may be associated with clinical benefit. Given the surgical risks and an 11% stoma rate, careful patient selection is essential. Complete gross resection was associated with improved progression-free and overall survival. Additional research is needed to clarify whether a survival benefit exists in cases with residual disease of 1 to 10 mm.

Evaluating the risk of diaphragmatic hernia following left diaphragm resections during cytoreductive surgery for ovarian cancer: a Memorial Sloan Kettering Cancer Center Team Ovary study

To determine the incidence rate and risk factors associated with the development of diaphragm hernias following left diaphragm procedures at the time of ovarian cancer cytoreduction. We retrospectively reviewed data from patients diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal carcinoma who underwent any timeframe of cytoreductive surgery (primary, interval, secondary, tertiary) at our institution from December 2010 to September 2024. Patients were included if they underwent left diaphragm peritonectomy or resection as part of their cytoreductive surgery. The diagnosis of left diaphragm hernia was made by computed tomography of the chest either as an incidental finding during follow-up surveillance or during work-up for symptomatology. We utilized statistical analysis with descriptive proportions with interquartile ranges. A total of 267 patients with ovarian cancer underwent a left diaphragm peritonectomy or resection as part of their cytoreductive surgery at our institution and were included in the study. The overall median age was 62 years (interquartile range; 52-70) and body mass index 24.9 kg/m Diaphragmatic hernias occurred most often following the setting of concurrent splenectomy; however, splenectomy was not a statistically significant risk factor. These findings provide meaningful insight into the frequency and clinical context in which this complication may arise, addressing a critical knowledge gap in the surgical management of patients with ovarian cancer who require upper abdominal and thoracic procedures.

Why was GOG-0213 a negative trial?