title: Optimal (≤1 cm) but visible residual disease: is extensive debulking warranted?
abstract: OBJECTIVE
  To determine if extensive upper abdominal surgery (UAS) affected overall survival (OS) in patients left with ≤ 1 cm but visible residual disease after undergoing primary cytoreductive surgery for ovarian cancer. Our secondary objective was to determine if leaving ≤ 1cm but visible residual throughout the small bowel (SB) conferred a worse prognosis.
  
  
  METHODS
  All stage IIIB-IV ovarian cancer patients who had visible but ≤ 1 cm residual disease at time of primary cytoreductive surgery from 2001 to 2010 were identified. Extensive UAS procedures and residual SB involvement were recorded.
  
  
  RESULTS
  The 219 patients identified with ≤1 cm but visible residual disease had a median OS of 51 months. In this cohort, 127 had extensive UAS performed, and 87 had residual disease involving the SB. Univariate OS analysis was performed. There was no significant difference in OS between patients who did or did not have extensive UAS (45 vs. 52 months, P=0.56), or between patients with or without residual SB disease (45 vs. 51 months, P=0.84). Factors that were significantly associated with OS were age, ASA score, family history, and stage.
  
  
  CONCLUSIONS
  Patients cytoreduced to ≤ 1 cm but visible residual disease who required UAS did not have a worse OS than those who did not require UAS. OS was similar if residual disease involved the SB or not. For ovarian cancer patients with disease not amenable to complete gross resection, extensive surgery should still be considered to achieve ≤ 1 cm but visible residual disease status, including cases where the residual disease involves the SB.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Barlin
authors.forename: K C
authors.initials: KC
authors.lastname: Long
authors.forename: E J
authors.initials: EJ
authors.lastname: Tanner
authors.forename: G J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: M M
authors.initials: MM
authors.lastname: Leitao
authors.forename: D A
authors.initials: DA
authors.lastname: Levine
authors.forename: Y
authors.initials: Y
authors.lastname: Sonoda
authors.forename: N R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: R R
authors.initials: RR
authors.lastname: Barakat
authors.forename: D S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Extensive surgery; Ovarian cancer; Overall survival; Small bowel