title: Impact of Neoadjuvant Chemotherapy on the Rate of Bowel Resection in Advanced Epithelial Ovarian Cancer.
abstract: To assess the decrease in the number of bowel resections (BR) necessary to achieve complete cytoreduction (CC-0) in advanced epithelial ovarian cancer (EOC) permitted by neoadjuvant chemotherapy (NAC).
  
  
  
  Patients were selected from a population of advanced EOC cases diagnosed between 2002 and 2009 at the Curie Institute: 97 patients with Federation International of Gynecology and Obstetrics IIIc and IV with unresectable disease treated with NAC followed by interval debulking surgery were included. We proceeded to a systematic blinded review of all the surgical reports pre-and post-NAC by two different surgeons to assess the surgical procedures required to obtain CC-0.
  
  
  
  Before NAC, at least 84 patients (87%) would have required BR to obtain a CC-0 resection. At interval debulking surgery, 47 (49%) still required a BR, which corresponds to a decrease of 38% (p<0.0001). The same decrease was observed for resection of small bowel, colon and rectosigmoid, as follows: 54 to 17 (77% to 24%, p<0.0001), 45 to 19 (56% to 24%, p<0.0001) and 72 to 25 (90% to 31%, p<0.0001), respectively. The median overall survival (OS) among CC-0 patients with and without BR was 57 months [95% confidence interval (CI)=25-90 months] and 50 months [95% CI=43-57 months], respectively (p=0.71). The OS among patients without complete resection was significantly worse, with a median of 21 months (95% CI=17-32 months, p<0.0001).
  
  
  
  NAC significantly reduces the need and rate of BR in advanced EOC, but also of small bowel, colon and rectosigmoid resection. There is no loss of OS, after BR especially if the debulking surgery is complete.
authors.affiliation: Department of Breast and Gynecological Surgery, René Huguenin Centre, Curie Institute, Saint Cloud, France Medical School, Claude Bernard Lyon 1 University, Villerbanne, France.
authors.forename: Charles-André
authors.initials: CA
authors.lastname: Philip
authors.affiliation: Department of Breast and Gynecological Surgery, René Huguenin Centre, Curie Institute, Saint Cloud, France EA 7285: Clinical Risks and Security in Women's Health and Perinatal Health, Versailles-St-Quentin-en-Yvelines University, St-Quentin-en-Yvelines, France a.komorek@gmail.com.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Pelissier
authors.affiliation: Department of Breast and Gynecological Surgery, René Huguenin Centre, Curie Institute, Saint Cloud, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bonneau
authors.affiliation: Department of Breast and Gynecological Surgery, René Huguenin Centre, Curie Institute, Saint Cloud, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Hequet
authors.affiliation: Department of Breast and Gynecological Surgery, René Huguenin Centre, Curie Institute, Saint Cloud, France EA 7285: Clinical Risks and Security in Women's Health and Perinatal Health, Versailles-St-Quentin-en-Yvelines University, St-Quentin-en-Yvelines, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Department of Breast and Gynecological Surgery, René Huguenin Centre, Curie Institute, Saint Cloud, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pouget
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
keywords: Advanced epithelial ovarian cancer; bowel resection; neoadjuvant chemotherapy