title: Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations.
abstract: BACKGROUND
  In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery.
  
  
  METHODS
  Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases.
  
  
  RESULTS
  Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10(-3)). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes.
  
  
  CONCLUSIONS
  In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.
authors.affiliation: Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.|Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Fabien
authors.initials: F
authors.lastname: Vidal
authors.affiliation: Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.
authors.forename: Haya
authors.initials: H
authors.lastname: Al Thani
authors.affiliation: Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.
authors.forename: Pascale
authors.initials: P
authors.lastname: Haddad
authors.affiliation: Department of Gynecologic Surgery, Saint Luc Academic Hospital, Catholic University of Louvain, Bruxelles, Belgium.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Luyckx
authors.affiliation: Comprehensive Cancer Center, Department of Surgery, Institut Bergonie, Bordeaux, France.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stoeckle
authors.affiliation: Department of Gynecologic Surgery, Institut Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.affiliation: Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lecuru
authors.affiliation: Department of Gynecologic Surgery, Tenon Hospital, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Department of Surgical Oncology, Centre Gauducheau, Comprehensive Cancer Center, Saint Herblain, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Department of Surgical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pomel
authors.affiliation: Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Mahfoud
authors.affiliation: Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France.
authors.forename: Gwenael
authors.initials: G
authors.lastname: Ferron
authors.affiliation: Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.affiliation: Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. jat2021@qatar-med.cornell.edu.|Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. jat2021@qatar-med.cornell.edu.|Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, Education City, Doha, Qatar. jat2021@qatar-med.cornell.edu.
authors.forename: Arash
authors.initials: A
authors.lastname: Rafii
mesh_terms: D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate