Aggressive surgical effort and improved survival in advanced-stage ovarian cancer

Giovanni D. Aletti, Sean Christopher Dowdy, Bobbie S. Gostout, Monica B. Jones, C. Robert Stanhope, Timothy O. Wilson, Karl C. Podratz, William Arthur Cliby

Research output: Contribution to journalArticle

308 Citations (Scopus)

Abstract

OBJECTIVE: Residual disease after initial surgery for ovarian cancer is the strongest prognostic factor for survival. However, the extent of surgical resection required to achieve optimal cytoreduction is controversial. Our goal was to estimate the effect of aggressive surgical resection on ovarian cancer patient survival. METHODS: A retrospective cohort study of consecutive patients with International Federation of Gynecology and Obstetrics stage IIIC ovarian cancer undergoing primary surgery was conducted between January 1, 1994, and December 31, 1998. The main outcome measures were residual disease after cytoreduction, frequency of radical surgical resection, and 5-year disease-specific survival. RESULTS: The study comprised 194 patients, including 144 with carcinomatosis. The mean patient age and follow-up time were 64.4 and 3.5 years, respectively. After surgery, 131 (67.5%) of the 194 patients had less than 1 cm of residual disease (definition of optimal cytoreduction). Considering all patients, residual disease was the only independent predictor of survival; the need to perform radical procedures to achieve optimal cytoreduction was not associated with a decrease in survival. For the subgroup of patients with carcinomatosis, residual disease and the performance of radical surgical procedures were the only independent predictors. Disease-specific survival was markedly improved for patients with carcinomatosis operated on by surgeons who most frequently used radical procedures compared with those least likely to use radical procedures (44% versus 17%, P < .001). CONCLUSION: Overall, residual disease was the only independent predictor of survival. Minimizing residual disease through aggressive surgical resection was beneficial, especially in patients with carcinomatosis.

Original languageEnglish (US)
Pages (from-to)77-85
Number of pages9
JournalObstetrics and Gynecology
Volume107
Issue number1
StatePublished - Jan 2006

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Ovarian Neoplasms
Survival
Carcinoma
Gynecology
Obstetrics
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Aletti, G. D., Dowdy, S. C., Gostout, B. S., Jones, M. B., Stanhope, C. R., Wilson, T. O., ... Cliby, W. A. (2006). Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstetrics and Gynecology, 107(1), 77-85.

Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. / Aletti, Giovanni D.; Dowdy, Sean Christopher; Gostout, Bobbie S.; Jones, Monica B.; Stanhope, C. Robert; Wilson, Timothy O.; Podratz, Karl C.; Cliby, William Arthur.

In: Obstetrics and Gynecology, Vol. 107, No. 1, 01.2006, p. 77-85.

Research output: Contribution to journalArticle

Aletti, GD, Dowdy, SC, Gostout, BS, Jones, MB, Stanhope, CR, Wilson, TO, Podratz, KC & Cliby, WA 2006, 'Aggressive surgical effort and improved survival in advanced-stage ovarian cancer', Obstetrics and Gynecology, vol. 107, no. 1, pp. 77-85.
Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstetrics and Gynecology. 2006 Jan;107(1):77-85.
Aletti, Giovanni D. ; Dowdy, Sean Christopher ; Gostout, Bobbie S. ; Jones, Monica B. ; Stanhope, C. Robert ; Wilson, Timothy O. ; Podratz, Karl C. ; Cliby, William Arthur. / Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. In: Obstetrics and Gynecology. 2006 ; Vol. 107, No. 1. pp. 77-85.
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abstract = "OBJECTIVE: Residual disease after initial surgery for ovarian cancer is the strongest prognostic factor for survival. However, the extent of surgical resection required to achieve optimal cytoreduction is controversial. Our goal was to estimate the effect of aggressive surgical resection on ovarian cancer patient survival. METHODS: A retrospective cohort study of consecutive patients with International Federation of Gynecology and Obstetrics stage IIIC ovarian cancer undergoing primary surgery was conducted between January 1, 1994, and December 31, 1998. The main outcome measures were residual disease after cytoreduction, frequency of radical surgical resection, and 5-year disease-specific survival. RESULTS: The study comprised 194 patients, including 144 with carcinomatosis. The mean patient age and follow-up time were 64.4 and 3.5 years, respectively. After surgery, 131 (67.5{\%}) of the 194 patients had less than 1 cm of residual disease (definition of optimal cytoreduction). Considering all patients, residual disease was the only independent predictor of survival; the need to perform radical procedures to achieve optimal cytoreduction was not associated with a decrease in survival. For the subgroup of patients with carcinomatosis, residual disease and the performance of radical surgical procedures were the only independent predictors. Disease-specific survival was markedly improved for patients with carcinomatosis operated on by surgeons who most frequently used radical procedures compared with those least likely to use radical procedures (44{\%} versus 17{\%}, P < .001). CONCLUSION: Overall, residual disease was the only independent predictor of survival. Minimizing residual disease through aggressive surgical resection was beneficial, especially in patients with carcinomatosis.",
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