Presenter of 2 Presentations
RADICAL CYTOREDUCTIVE SURGERY OF THE UPPER ABDOMEN FOR ADVANCED OVARIAN CANCER
Abstract
Introduction
Volume of residual disease following cytoreductive surgery for patients with advanced ovarian, fallopian tube, and peritoneal carcinoma is one of the most important factors for overall survival. Extensive upper abdominal resections was not initially part of the surgical armamentarium of advanced ovarian cancer management for Gynecologic Oncologists. Large-volume upper abdominal tumor involving the diaphragm, liver, and/or spleen was deemed “unresectable,” and the patient was left with suboptimal residual disease. The incorporation of upper abdominal comprehensive surgical techniques has led to a significant improvement in optimal cytoreduction rates, and ultimately improved progression-free and overall survival.
Description
In this film we demonstrate the steps of open abdominal radical debulking surgery for high-grade ovarian carcinoma including a splenectomy, pancreatectomy, and full thickness diaphragm resection with excision of a cardiophrenic lesion. We also demonstrate potential complications as well as strategies to repair and limit these.
Conclusion/Implications
This surgical film demonstrates the feasibility and techniques involved for performing a splenectomy, pancreatectomy, and full thickness diaphragm resection with excision of a cardiophrenic lesion. Additionally, we demonstrate strategies to limit and manage post-operative complications associated with these surgeries. We hope this video will provide physicians with tools to incorporate into their practice in order to improve outcomes for their patients.
INTRATHORACIC SURGERY AS PART OF PRIMARY CYTOREDUCTION FOR ADVANCED OVARIAN CANCER - GOING TO THE NEXT LEVEL: A MEMORIAL SLOAN KETTERING TEAM OVARY STUDY
Abstract
Objectives
We report on a cohort of patients undergoing intrathoracic cytoreduction as part of primary debulking surgery (PDS), assessing safety and survival outcomes.
Methods
We conducted a single center, database review of patients with stage IIIB-IV ovarian carcinoma who underwent intrathoracic cytoreduction as part of PDS at our institution between 01/2001-12/2019. Patients were excluded if they received neoadjuvant chemotherapy.
Results
During the study, 179 patients had intrathoracic surgery as part of PDS. This represents 11% (179/1579) of patients who had a PDS at our institution during this time. Supradiaphragmatic/cardiophrenic lymph nodes were excised in 64% of patients (114/179); mediastinal (not cardiophrenic) nodes 13% (23/179); pleural nodules 7% (12/179); lung parenchyma 1% (2/179), and multiple intrathoracic areas 16% (28/179). Complete gross resection (CGR) was achieved in 73% of patients (127/179), 26% (44/179) had optimal cytoreduction (1-10 mm of residual disease (RD)), and 1% (2/179) underwent suboptimal cytoreduction (>10 mm of RD). Median length of follow-up among survivors was 55 months. Patients with an intrathoracic cytoreduction of carcinoma where CGR was achieved had a median OS of 97 months versus 54 months following an optimal cytoreduction with RD (p = 0.0036). Patients with an intrathoracic cytoreduction where CGR was achieved had a median PFS of 22.1 months versus 14.4 months following an optimal cytoreduction with RD (p = 0.04).
Conclusions
Intrathoracic cytoreduction during PDS for advanced ovarian cancer is safe and feasible. CGR can be obtained in patients with intrathoracic disease if properly selected. Resection of all gross RD including intrathoracic disease significantly improves both PFS and OS.