title: Extensive cytoreductive surgery in advanced ovarian carcinoma.
abstract: From June 1985 to June 1993, 152 patients with advanced ovarian cancer were treated with maximum cytoreductive surgery, and six to nine cycles of platinum-based chemotherapy. Six patients had stage IIIA-B disease, 101 stage IIIC, and 45 stage IV. Twenty-two tumors were grade 1. 58, grade 2. and 72, grade 3. Eighty-four patients (55%) presented with bulky tumors (> 10 cm in diameter). Optimal cytoreductive surgery (diameter of largest residual mass < 2 cm) was performed in 138 patients (91%). Fifty patients (33%) developed postoperative complications; 38 patients (25%) required a second laparotomy within a few days. Two postoperative deaths occurred. Overall 2-year and 4-year survival rates were 56% and 28%, respectively. There was a clear relationship between residual tumor and survival: the 2-year survival rate was 80% in the absence of residual tumor vs. 22% when the residuum exceeded 2 cm in diameter. The 2-year survival rate was 49% for tumor nodules < 2 cm in diameter. In a multivariate analysis of various risk factors (grade, stage, lymph node metastases, residual tumor, and age), the one that correlated most with survival was residual tumor. Despite a high morbidity rate, this modality of treatment, with the presence of optimal and aggressive perioperative measures in terms of intensive care unit and post-operative follow-up, offers an encouraging if not promising strategy for increased chances of survival in advanced ovarian cancer.
authors.affiliation: Department of Surgery, Gustave Roussy Institute, Cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Michel
authors.forename: P
authors.initials: P
authors.lastname: De Iaco
authors.forename: D
authors.initials: D
authors.lastname: Castaigne
authors.forename: M J
authors.initials: MJ
authors.lastname: el-Hassan
authors.forename: R
authors.initials: R
authors.lastname: Lobreglio
authors.forename: C
authors.initials: C
authors.lastname: Lhommé
authors.forename: A
authors.initials: A
authors.lastname: Rey
authors.forename: P
authors.initials: P
authors.lastname: Duvillard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D015996:Survival Rate