title: The Prognostic Role of Optimal Cytoreduction in Advanced, Bowel Infiltrating Ovarian Cancer.
abstract: OBJECTIVE
  In locally advanced ovarian cancer with bowel involvement appropriate surgical treatment is still controversial. Objective was to delineate factors to select those most likely to benefit from radical surgery in patients with locally advanced ovarian cancer.
  
  
  METHODS
  Therefore, we retrospectively evaluated 207 consecutive patients with primary stage IIB-IV ovarian cancer who underwent primary surgery between 2000 and 2007. Every patient received stage-related surgery and adjuvant platinum-based chemotherapy. Median follow-up was 53.5 months. Data collected included stage, histology, extent of cytoreduction and type of bowel resection. Univariate survival analyses were performed to investigate variables associated with outcome.
  
  
  RESULTS
  Optimal cytoreduction (OCR) (R ≤ 1 cm) was achieved in 76.8%. Most patients presented histologic grade 2/3 (96.6%), serous ovarian cancers (84.1%) and lymph node involvement (52.2%). Complete cytoreduction (R = 0 mm) has significant best prognostic impact in FIGO IIB-IV (p = .026). Regarding bowel involvement, bowel resection was performed in 82 patients (39.6%). In this subgroup of patients complete cytoreduction led to significant better overall survival than R > 0 mm-1 cm, even in FIGO IIIC-IV patients (p = .027); this fact is independent of bowel resection. Noticeably, for survival bowel resection achieving residual tumor mass below 1 cm was also one main prognostic factor and even recurrence rate was associated with residual tumor mass.
  
  
  CONCLUSIONS
  Our findings suggest that the major prognostic factor in patients with advanced ovarian cancer needing colorectal resection is completeness of cytoreduction. Therefore, in advanced ovarian cancer patients, multivisceral surgery is indicated to achieve OCR (R ≤ 1 cm) with or without bowel resection with best prognostic impact.
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital , Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bachmann
authors.forename: Ralf
authors.initials: R
authors.lastname: Rothmund
authors.forename: Bernhard
authors.initials: B
authors.lastname: Krämer
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Brucker
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.forename: Ingmar
authors.initials: I
authors.lastname: Königsrainer
authors.forename: Stefan
authors.initials: S
authors.lastname: Beckert
authors.forename: Anette
authors.initials: A
authors.lastname: Staebler
authors.forename: Phuc
authors.initials: P
authors.lastname: NguyenHuu
authors.forename: Eva
authors.initials: E
authors.lastname: Grischke
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Cornelia
authors.initials: C
authors.lastname: Bachmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000175:diagnosis / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies
keywords: bowel resection; ovarian cancer; prognosis; recurrence; residual tumor; surgery