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Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center.

Methods/materials

A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis.

Results

We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19–91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100–540 min). Median surgical complexity score was 10 (range 5–15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0–104) and 8 days (range 4–118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks.

Conclusions

Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses.

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Acknowledgments

The authors want to thank Stephen Shephard and Tommy Gorgy for their help in collecting the data.

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Authors and Affiliations

  1. West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK

    Christina Fotopoulou, Benjamin P Jones, Maria Kyrgiou, Alan Farthing & Hani Gabra

  2. Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK

    Christina Fotopoulou, Maria Kyrgiou & Hani Gabra

  3. Department of Cardiology, Barts Healthcare NHS Trust Hospital, London, UK

    Konstantinos Savvatis

  4. Department of Anesthetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 OHS, UK

    Jeremy Campbell

  5. Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK

    Stephen Brett & Richard Stümpfle

  6. Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK

    Rene Roux, Marcia Hall & Gordon Rustin

  7. Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, W12 0HS, UK

    Long Jiao

Authors
  1. Christina Fotopoulou
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  2. Benjamin P Jones
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  3. Konstantinos Savvatis
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  4. Jeremy Campbell
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  12. Long Jiao
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  13. Richard Stümpfle
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Corresponding author

Correspondence to Christina Fotopoulou.

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Conflict of interest

Professor Christina Fotopoulou is an associate editor for Archives of Gynecology and Obstetrics. No other conflicts of interests to disclose.

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Fotopoulou, C., Jones, B.P., Savvatis, K. et al. Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities. Arch Gynecol Obstet 294, 607–614 (2016). https://doi.org/10.1007/s00404-016-4080-3

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  • DOI: https://doi.org/10.1007/s00404-016-4080-3

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