Complete surgical cytoreduction of advanced ovarian carcinoma using the argon beam coagulator.
OBJECTIVE
The aim of this study was to evaluate the utility of the argon beam coagulator (ABC) in achieving optimal (< or =1 cm) disease status and facilitating the conversion of optimal but visible disease (0.1-1.0 cm) to microscopic residual disease (complete cytoreduction) among patients with advanced ovarian carcinoma.


METHODS
All patients undergoing their primary attempt at surgical cytoreduction for Stage IIIB-IV epithelial ovarian carcinoma between October 1, 1997 and June 30, 2000 were identified from the tumor registry database. Data were abstracted retrospectively and included: the size/location of precytoreduction disease, surgical procedures performed, the anatomic regions in which the ABC was used for cytoreduction, the size/location of residual tumor, and the date of last follow-up and disease status. Survival curves were generated using the Kaplan-Meier method, and statistical comparisons were performed using the chi(2) test, Fisher's exact test, log rank test, and multivariate logistic regression.


RESULTS
Forty-five patients were identified (FIGO Stage IIIB = 8, Stage IIIC = 29, Stage IV = 8). Overall, optimal cytoreduction was achieved in 84.4% of patients; 60.0% had only microscopic residual and 24.4% had residual disease 0.1-1.0 cm. The ABC was used to facilitate cytoreduction in 31 patients. Optimal disease status was achieved in 93.6% of cases in which the ABC was used compared with 64.3% for non-ABC cases (P < 0.023). ABC use was also associated with a higher rate of complete cytoreduction (74.2%) compared with non-ABC cases (28.6%, P < 0.004). Among patients left with optimal disease (< or =1 cm), conversion to only microscopic residual was achieved in 79.3% of cases using the ABC and 44.4% of cases without ABC use (P < 0.044). The ABC was associated with a statistically significantly higher rate of complete cytoreduction for disease located in the lesser sac/gastrocolic ligament (90.9% vs 14.3%), abdominal peritoneum (95.5% vs 50.0%), bowel mesentery (80.0% vs 0), and pelvis (89.3% vs 50.0%). Multivariate analysis revealed that use of the ABC (P = 0.006) and disease in three or fewer anatomic regions (P = 0.014) were independent predictors of a microscopic residual surgical outcome. Complete cytoreduction was associated with a significant advantage in median progression-free survival (22.2 months) compared with patients with optimal but visible (0.1-1.0 cm) residual disease (12.3 months) and those with suboptimal (>1.0 cm) residual disease (6.3 months, P < 0.001). Among ABC cases, the mean estimated blood loss was 527 ml, and major postoperative complications occurred in 9.7% of patients.


CONCLUSIONS
The ABC is a useful adjunct to conventional tumor reductive techniques and appears to significantly increase the feasibility of achieving both optimal disease status and complete cytoreduction of all visible tumor in patients with macroscopic metastatic ovarian carcinoma.
Bristow
R E
RE
The Kelly Gynecologic Oncology Service, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-1248, USA. rbristo@jhmi.edu
Montz
F J
FJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome