title: Aggressive surgical effort and improved survival in advanced-stage ovarian cancer.
abstract: OBJECTIVE
  Residual disease after initial surgery for ovarian cancer is the strongest prognostic factor for survival. However, the extent of surgical resection required to achieve optimal cytoreduction is controversial. Our goal was to estimate the effect of aggressive surgical resection on ovarian cancer patient survival.
  
  
  METHODS
  A retrospective cohort study of consecutive patients with International Federation of Gynecology and Obstetrics stage IIIC ovarian cancer undergoing primary surgery was conducted between January 1, 1994, and December 31, 1998. The main outcome measures were residual disease after cytoreduction, frequency of radical surgical resection, and 5-year disease-specific survival.
  
  
  RESULTS
  The study comprised 194 patients, including 144 with carcinomatosis. The mean patient age and follow-up time were 64.4 and 3.5 years, respectively. After surgery, 131 (67.5%) of the 194 patients had less than 1 cm of residual disease (definition of optimal cytoreduction). Considering all patients, residual disease was the only independent predictor of survival; the need to perform radical procedures to achieve optimal cytoreduction was not associated with a decrease in survival. For the subgroup of patients with carcinomatosis, residual disease and the performance of radical surgical procedures were the only independent predictors. Disease-specific survival was markedly improved for patients with carcinomatosis operated on by surgeons who most frequently used radical procedures compared with those least likely to use radical procedures (44% versus 17%, P < .001).
  
  
  CONCLUSIONS
  Overall, residual disease was the only independent predictor of survival. Minimizing residual disease through aggressive surgical resection was beneficial, especially in patients with carcinomatosis.
  
  
  METHODS
  II-2.
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: Aletti
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Bobbie S
authors.initials: BS
authors.lastname: Gostout
authors.forename: Monica B
authors.initials: MB
authors.lastname: Jones
authors.forename: C Robert
authors.initials: CR
authors.lastname: Stanhope
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Wilson
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome