title: Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities.
abstract: To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center.
  
  
  
  A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis.
  
  
  
  We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19-91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100-540 min). Median surgical complexity score was 10 (range 5-15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0-104) and 8 days (range 4-118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks.
  
  
  
  Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses.
authors.affiliation: West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK. chfotopoulou@gmail.com.|Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK. chfotopoulou@gmail.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Fotopoulou
authors.affiliation: West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Barts Healthcare NHS Trust Hospital, London, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Savvatis
authors.affiliation: Department of Anesthetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 OHS, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Campbell
authors.affiliation: West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK.|Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Kyrgiou
authors.affiliation: West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Farthing
authors.affiliation: Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brett
authors.affiliation: Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK.
authors.forename: Rene
authors.initials: R
authors.lastname: Roux
authors.affiliation: Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK.
authors.forename: Marcia
authors.initials: M
authors.lastname: Hall
authors.affiliation: Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Rustin
authors.affiliation: West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK.|Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK.
authors.forename: Hani
authors.initials: H
authors.lastname: Gabra
authors.affiliation: Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, W12 0HS, UK.
authors.forename: Long
authors.initials: L
authors.lastname: Jiao
authors.affiliation: Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Stümpfle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D055815:Young Adult
keywords: Albumin; Cytoreduction; Morbidity; Mortality; Multivisceral; Ovarian cancer