title: Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease: an analysis of Gynecologic Oncology Group (GOG) 182.
abstract: OBJECTIVE
  To examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival.
  
  
  METHODS
  We reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease <1cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan-Meier and proportional hazards methods.
  
  
  RESULTS
  Four-hundred eighty-two patients (18.1%) underwent a total of 590 UAPs. There were 351 (13.1%) diaphragm surgeries, 112 (4.2%) liver surgeries, 108 (4%) splenectomies, 12 (0.5%) pancreatectomies, and 7 (0.2%) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2 months (mos) and 14.8 mos (p < 0.01) and OS was 49.8 mos v. 43.7 mos (p = 0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR = 1.03, 95% CI 0.91-1.15; OS HR=0.92, 95%CI 0.81-1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4 mos (p=0.0005).
  
  
  CONCLUSIONS
  UAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Rodriguez
authors.forename: Austin
authors.initials: A
authors.lastname: Miller
authors.forename: Scott D
authors.initials: SD
authors.lastname: Richard
authors.forename: Bunja
authors.initials: B
authors.lastname: Rungruang
authors.forename: Chad A
authors.initials: CA
authors.lastname: Hamilton
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bookman
authors.forename: G Larry
authors.initials: GL
authors.lastname: Maxwell
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery*; D000077216:Carcinoma, Ovarian Epithelial; D003964:Diaphragm / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D009375:Neoplasms, Glandular and Epithelial / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery*; D010180:Pancreatectomy; D013156:Splenectomy
keywords: Ovarian cancer; Surgical debulking; Upper abdominal procedures