Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review

HANPRASERTPONG J. & FUJIWARA K. (2011) European Journal of Cancer Care 20 , 287–293
Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review Surgical cytoreduction and platinum/taxane combination chemotherapy are the mainstay for the treatment of epithelial ovarian cancer patients. In order to minimise the tumour mass before chemotherapy, cytoreductive surgery is usually performed first. Currently, a splenectomy is included as part of surgical cytoreduction in epithelial ovarian cancer, but it is rarely performed. A splenectomy is also performed as part of secondary cytoreduction surgery. Although there are many reports on surgical techniques, safety and associated clinical outcomes of a splenectomy as a standard adjunct of ovarian cytoreductive surgery, most evidence is from case(s) reports, with only a few studies. Thus, we conducted a review of the literature on this unusual procedure in the context of primary and secondary cytoreduction of epithelial ovarian cancer to assess the published evidence for its efficacy and safety.     

铂敏感复发性卵巢癌手术治疗的研究进展

复发性卵巢癌的高发率及致死率一直是临床上的难题.对部分铂类敏感的复发性卵巢癌患者,采用二次肿瘤细胞减灭术(SCS)及以铂类为基础的后续联合化疗可以延长生存时间,改善生活质量.因此,正确识别可以受益于手术治疗的患者是关键问题.目前已有研究提出一些预测模型来选择适合SCS的患者.本文就近年来对铂敏感复发性卵巢癌手术治疗的研...     

卵巢癌的新辅助化疗与间隔减瘤术

在过去10年中,晚期卵巢癌的新辅助化疗和间隔减瘤术一直是人们关注的焦点,全文回顾了近年来的有关文献,认为对于那些预计首次手术无法切除的晚期卵巢癌,由于缺乏随机对照研究证实新辅助化疗能够改善生存,尚不能作为常规治疗手段来使用。同时,探讨了欧洲和美国的两项有关卵巢癌间隔减瘤术的随机对照研究。     

Pregnancy Outcomes after Conservative Surgery for Early-Stage Ovarian Neoplasms

Objective: This retrospective, single institute study aimed to evaluate pregnancy and oncologic outcomes in reproductive-age Thai women with early-stage ovarian neoplasms undergoing conservative surgical treatment. Methods: Medical records of 84 women of reproductive age (15-45 years) with histologically confirmed early-stage (IA-IIC) borderline ovarian tumors or cancers who had undergone conservative surgery between January 2003 and December 2012 were retrospectively reviewed. Results: The mean age of patients at diagnosis was 28.0 years (SD 7.2). Histologically, 30 (35.7%) had borderline ovarian tumors, 28 (33.3%) epithelial cancers, 22 (26.2%) malignant germ cell tumors, and 4 (4.8%) sex cord stromal tumors. Thirty-five women (41.7%) had complete surgical staging performed, whereas 49 (58.3%) underwent an incomplete staging procedure. Thirty-four patients (40.5%) received postoperative chemotherapy. Among 29 patients subsequently attempting pregnancy, 15 conceived successfully (51.7%). Pregnancy outcomes were one spontaneous abortion and 14 viable births. There were no serious adverse obstetric and neonatal outcomes among women with documented live births and no reported fetal abnormalities. Pregnancy rates were not impacted by surgical staging (53.8% vs 50.0%, p=0.837) or adjuvant chemotherapy (55.6% vs 50.0%, p=0.782). The 5-year disease-free survival was 91.0% and pregnancy after conservative surgery did not affect progression-free survival (p=0.194). Conclusion: Conservative surgery with or without appropriate adjuvant chemotherapy can be offered to young women with early-stage ovarian neoplasms who wish to preserve their fertility potential.     

Novel Directions in Adjuvant Chemotherapy for Early Stage Epithelial Ovarian Cancer

Treatment of early stage ovarian cancer remains controversial despite advances in chemotherapeutic options.Over the past 30 years, molecular and clinicopathologic studies accelerated and treatment of ovarian cancer hasundoubtedly improved although there is a debate as to whether this impacts outcome or not. More recently, theintroduction of targeted therapy started a new era. Probably it is because early stage disease comprises a smallportion of the epithelial ovarian cancer, studies have mostly ignored this group and still there is no clear consensusregarding systemic treatment of early-stage lesions. However this group of patients has the best chance of cure.In this review, we focus on current developments in the treatment of early stage ovarian cancer and query theoptions.     

Patterns of pathological response to neoadjuvant chemotherapy and its clinical implications in patients undergoing interval cytoreductive surgery for advanced serous epithelial ovarian cancer- A study by the Indian Network for Development of Peritoneal Surface Oncology (INDEPSO)

ObjectivesThe goals were to study• The pattern of pathological response to neoadjuvant chemotherapy (NACT) and its clinical implications• The impact of chemotherapy response grade (CRG) on survivalMethodsA retrospective analysis of patients undergoing interval cytoreductive surgery (CRS) between January 2013 to December 2017 was performed. The surgical and pathological reports were analyzed and surgical and pathological PCI compared. The pathological response to chemotherapy was assessed using the score developed by Bohm. et al.ResultsIn 79 patients, it was observed that sites involved by disease first like ovaries and pelvic peritoneum (lower region) were the last to respond preceded by the omentum, right upper quadrant (RUQ) peritoneum (upper region) and parietal peritoneum (middle region). Microscopic residual disease was seen in 20.2% in normal looking areas of peritoneum and in 20% with no gross residual disease in the RUQ. Visual inspection during surgery overestimated the disease extent in 40.5% and underestimated it in 15.1%.There was no difference in the progression free (p = 0.587) and overall survival (p = 0.157) between patients with CRG 1, 2 and 3 (poor, moderate, and complete/near complete response, respectively). Retroperitoneal nodes were positive in 0% with CRG 3, 27.5% with CRG 2 and 72.7% with CRG 1 (p < 0.0001).ConclusionsThe pathological response to NACT follows a specific pattern. Visual inspection is of limited value in assessing disease extent following NACT. Surgery following NACT should target sites involved before NACT and not just residual disease. The response in regional nodes should be included in chemotherapy response scores.     

早期上皮性卵巢癌保留生育功能手术的安全性及可行性探讨

目的探讨早期上皮性卵巢癌保留生育功能手术的安全性及可行性。方法选取33例早期上皮性卵巢癌患者为研究对象,根据患者自愿选择治疗方式,将其分为保留生育功能手术组和卵巢癌根治性手术组。评估两组的近期疗效并随访2年;记录患者随访期间复发情况、手术前后月经变化情况及孕产情况等。结果在33例患者中,15例选择保留生育功能手术,18例选择卵巢癌根治性手术;在随访期内,保留生育功能手术患者中3例复发,11例月经恢复正常,5例孕育成功并分娩健康儿;两组患者随访期间生存率比较差异无统计学意义(P>0.05);卵巢癌根治性手术组和保留生育功能手术组的部分缓解率为46.7%和27.8%。疾病控制率分别为86.7%和55.6%。结论对早期上皮性卵巢癌患者实施保留生育功能手术是可行的,且临床较为安全,但需加强术后随访和指导,以提高临床安全性。     

妊娠及围产期卵巢上皮性癌3例分析及文献回顾

妊娠及围产期上皮性卵巢癌（EOC）是威胁母婴健康的恶性疾病之一,发生率低,早期诊断困难,且对生命及家庭生活会产生巨大的影响。本文通过详尽分析3例妊娠及围产期上皮性卵巢癌病例的诊断、治疗经过及结局,并回顾相关文献报道,以提出对该病的治疗建议。通过病例分析及文献回顾发现妊娠合并EOC早期诊断困难,肿瘤标志物及B超诊断价值有限。一旦诊断,是否继续妊娠以及手术化疗的治疗方案要根据患者及其家庭情况多方面考量,充分沟通,每个患者均应获得个体化治疗方案。目前预后尚存在不确定性。     

Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer—a propensity score-matching analysis

BackgroundSplenic flexure cancer (SFC) is a rare condition in colorectal cancer (CRC). The appropriate surgical treatment for SFC remains controversial. In recent years, we have used artery-guided segmental splenic flexure colectomy (ASFC) to treat SFC in which robotic access is gradually applied. The study sought to assess the clinical and oncologic outcomes of robotic-assisted ASFC compared to laparoscopic-assisted ASFC for SFC by undertaking a propensity score-matching analysis.MethodsSeventy patients underwent a robotic-assisted ASFC (n=19) or laparoscopic-assisted ASFC (n=51) to treat SFC from Dec 2015 to Dec 2019. Their data were prospectively collected. The patients were matched at a ratio of 1:1 according to sex, age, body mass index (BMI), comorbidities, the American Society of Anesthesiologists (ASA) score (≤2 or >2), previous abdominal surgeries, and pathologic stage.ResultsNo statistically significant differences were found between the robotic- and laparoscopic-assisted ASFC groups in relation to operation time, estimated blood loss, length of postoperative hospital stay, time to liquid diet, postoperative complications, tumor size, distal resection margins, histology, lymph node harvest, metastatic lymph nodes, and neuro-vascular invasion. Additionally, no case was converted to a laparotomy. There were no cases readmission or mortality within 30 days of surgery. The distal resection margins were longer in the robotic-assisted ASFC group than the laparoscopic-assisted ASFC group. The robotic-assisted ASFC group had significantly higher operation expenses than the laparoscopic-assisted ASFC group. However, there was no significant difference in the surgical material expenses between the two groups. There were 2 cases of complications in each group; both cases were classified as grade I or II under Dindo’s classification of surgical complications.ConclusionsWith the exception of operation expenses, robotic-assisted ASFC rivals laparoscopic-assisted ASFC in many respects. ASFC meets the recommended oncological criteria in terms of resection margins and lymph node harvest. We await the results for the long-term oncologic outcomes.     

Comprehensive approach to advanced primary and recurrent ovarian cancer: a personal experience

Despite improvements in chemotherapy agents and schedules and new drug combinations, epithelial ovarian cancer remains a leading cause of gynecologic cancer death in Western countries. It is usually diagnosed at late stages of the disease, which makes complete surgical resection technically more difficult. The targeted comprehensive approach described in this review includes cytoreductive surgery and perioperative intraperitoneal chemotherapy. The goal of this aggressive therapy is to remove all the macroscopic disease with the use of peritonectomy procedures and visceral resections, and also to eradicate microscopic disease using heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. Patients that received a complete cytoreduction followed by perioperative intraperitoneal chemotherapy had an improved survival, with reasonable morbidity and mortality, as compared with those who received incomplete cytoreduction.     

Prognostic factors of secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer

Objective

The objective of this study was to identify the prognostic factors of secondary cytoreductive surgery on survival in patients with recurrent epithelial ovarian cancer.

Methods

The medical records of all patients who underwent secondary cytoreductive surgery between May 2001 and October 2007 at the National Cancer Center, Korea were reviewed. Univariate and multivariate analyses were executed to evaluate the potential variables for overall survival.

Results

In total, 54 patients met the inclusion criteria. Optimal cytoreduction to <0.5 cm residual disease was achieved in 87% of patients who had received secondary cytoreductive surgery. Univariate analysis revealed that site of recurrence (median survival, 53 months for the largest tumors in the pelvis vs. 24 months for the largest tumors except for the pelvis; p=0.007), progression free survival (PFS) (median survival, 43 months for PFS≥12 months vs. 24 months for PFS<12 months; p=0.036), and number of recurrence sites (median survival, 49 months for single recurred tumor vs 29 months for multiple recurred tumors; p=0.036) were significantly associated with overall survival. On multivariate analysis, prognostic factors that correlated with improved survival were site of recurrence (p=0.013), and PFS (p=0.043).

Conclusion

In the author''s analysis, a significant survival benefit was identified for the recurred largest tumors within the pelvis and PFS≥12 months. Secondary cytoreductive surgery should be offered in selected patients and large prospective studies are needed to define the selection criteria for secondary cytoreductive surgery.     

间歇性肿瘤细胞减灭术与初始肿瘤细胞减灭术对晚期上皮性卵巢癌的疗效评价

目的探讨间歇性肿瘤细胞减灭术(IDS)与初始肿瘤细胞减灭术(PDS)对晚期上皮性卵巢癌(EOC)的疗效。方法根据手术方法的不同将132例晚期EOC患者分为PDS组(n=87例)和IDS组(n=45)。PDS组患者行PDS手术后接受6~8个疗程的化疗。IDS组患者行PDS手术后接受3个疗程的化疗,然后再行IDS手术后化疗3~5个疗程。观察两组患者的PDS切除范围,比较两组患者的减瘤满意率、疗效、血清CA125水平和不良反应发生情况。结果IDS组患者的PDS切除范围明显小于PDS组(P﹤0.01)。IDS组患者的减瘤满意率高于PDS组(P﹤0.05)。IDS组患者的临床疗效明显优于PDS组(P﹤0.01)。术前和第3次化疗后,两组患者的血清CA125水平比较,差异均无统计学意义(P﹥0.05)。IDS组患者PDS后的血清CA125水平高于PDS组,完成化疗后的血清CA125水平低于PDS组(P﹤0.05)。IDS组患者的不良反应总发生率低于PDS组(P﹤0.05)。结论IDS有助于提高晚期EOC患者的手术减瘤满意率和近期疗效,且不会显著增加不良反应。     

93例复发性卵巢癌疗效分析

目的预测卵巢癌易复发因素,分析复发性卵巢癌(ROC)患者的疗效与预后。方法回顾性分析93例ROC患者的临床资料。采用单变量分析ROC患者无瘤生存期(DFI)影响因素。评估不同治疗方法对ROC患者无进展生存期(PFS)和复发后总生存时间(OS)的影响。结果初次治疗后DFI单变量分析显示:肿瘤的组织分化程度、临床分期、初次术后残留肿瘤大小、初次手术后化疗疗程数与DFI有关(均P<0.05)。93例ROC患者中,手术组:44例患者行二次肿瘤细胞减灭术(SCS),并联合化疗和(或)靶向治疗;非手术组:49例患者行单纯化疗和(或)靶向治疗。手术组PFS和复发后OS均较非手术组有所延长;手术组中:CA125≤150 U/L的患者OS和PFS较CA125>150 U/L的患者均有所延长(均P<0.05);术前影像学检查提示复发肿瘤个数≤3的患者术后OS和PFS较复发肿瘤个数>3的患者均有所延长(P<0.05)。结论肿瘤病理分化程度越高、临床分期越早、初次术后残余病灶越小以及术后化疗疗程越规范足量的卵巢癌患者DFI越长、复发越晚。卵巢癌复发时CA125≤150 U/L、影...     

Phase III trial of upfront debulking surgery versus neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers: Japan Clinical Oncology Group Study JCOG0602

On the basis of promising results of neoadjuvant chemotherapy (NAC) in our previous study (JCOG0206), we have been performing a Phase III study of treatment starting with NAC versus standard treatment starting with primary debulking surgery (PDS) for Stage III/IV müllerian carcinomas (ovarian, tubal and peritoneal carcinomas) since November 2006. The purposes are to prove the non-inferiority of the efficacy and to show the decrease in adverse effects resulting from reduced surgical invasiveness of treatment starting with NAC. Three hundred patients with advanced müllerian carcinomas will be randomized during 3 years. NAC arm patients undergo four cycles of NAC with paclitaxel plus carboplatin followed by interval debulking surgery and an additional four cycles of postsurgical chemotherapy. Standard arm patients undergo PDS and eight cycles of postsurgical chemotherapy with or without interval debulking surgery. The primary endpoint is overall survival. The major secondary endpoints are the incidence of adverse events and parameters representing surgical invasiveness.     

Morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with carboplatin used for ovarian,tubal, and primary peritoneal cancer

Background and objectives: Hypertherm intraperitoneal chemotherapy (HIPEC) is increasingly used in the treatment of ovarian, tubal, and primary peritoneal cancer (OC). The aim was to evaluate short-term morbidity of cytoreductive surgery (CRS) and carboplatin HIPEC. Methods: Prospective feasibility study performed from January 2016 to December 2017. Twenty-five patients with primary OC (FIGO III-IV) received upfront or interval CRS combined with carboplatin HIPEC at dose 800 mg/m ². Primary outcome measurements: grade 3 to 5 adverse events within 30 days according to Common Terminology Criteria for Adverse Events. Secondary outcome measurements: reoperation rate, length of hospital stay, readmission rate, and time from surgery to systemic chemotherapy administration. Results: No deaths (grade 5) or grade 4 adverse events were observed. Eleven patients (44.0%) experienced at least one grade 3 adverse event, the most common being an infection (28.0%) and neutropenia (12.0%). The reoperation rate was 8.0%. The median hospital stay was 14 days (range 9-25 days), and five patients (25.0%) were readmitted within 30 days after surgery. Median time from surgery to the administration of the first dose of systemic chemotherapy was 41 days (range 24-81 days). Conclusion: Our small-scale prospective study supports that CRS and carboplatin HIPEC used for primary advanced-stage OC is feasible with acceptable morbidity.     

Risks and benefits of systematic lymphadenectomy during interval debulking surgery for advanced high grade serous ovarian cancer

BackgroundLymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).MethodsA retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates.ResultsWe included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p < 0.001, respectively).ConclusionLymphadenectomy during IDS does not improve survival and increases post-operative complications.