title: What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study.
abstract: BACKGROUND
  The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery.
  
  
  METHODS
  Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP-), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan-Meier and proportional hazards methods.
  
  
  RESULTS
  There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP- group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P < .0001) and OS (53.3 vs 42.8 months; P < .0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration.
  
  
  CONCLUSIONS
  RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985-93. © 2016 American Cancer Society.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia of Augusta University, Augusta, Georgia.
authors.forename: Bunja J
authors.initials: BJ
authors.lastname: Rungruang
authors.affiliation: Gynecologic Oncology Group, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Austin
authors.initials: A
authors.lastname: Miller
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Western Pennsylvania Allegheny Hospital, Pittsburgh, Pennsylvania.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Irvine Medical Center, Irvine, California.
authors.forename: Noah
authors.initials: N
authors.lastname: Rodriguez
authors.affiliation: Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Hamilton
authors.affiliation: Division of Gynecologic Oncology, Department Obstetrics and Gynecology, Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Floor J
authors.initials: FJ
authors.lastname: Backes
authors.affiliation: Department of OB/GYN and Women's Health, University of Minnesota School of Medicine, Minneapolis, Minnesota.
authors.forename: Linda F
authors.initials: LF
authors.lastname: Carson
authors.affiliation: Department of Cancer Medicine, ANZGOG, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedlander
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goodheart
authors.affiliation: Department of Obstetrics and Gynecology, University of California Medical Center-Irvine, Orange, California.
authors.forename: Krishnansu S
authors.initials: KS
authors.lastname: Tewari
authors.affiliation: Department of Gynecology Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wenham
authors.affiliation: Medical Oncology, Arizona Oncology, Tuscon, Arizona.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bookman
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Inova Fairfax Hospital Women's Center, Falls Church, Virginia.
authors.forename: G Larry
authors.initials: GL
authors.lastname: Maxwell
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Richard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012187:Retroperitoneal Space / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: disease burden; lymphadenectomy; ovarian cancer; retroperitoneal exploration; surgical debulking