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A novel algorithm for the treatment strategy for advanced epithelial ovarian cancer: consecutive imaging, frailty assessment, and diagnostic laparoscopy

Authors :
Eun Ji Nam
Sunghoon Kim
Jung-Yun Lee
Sang Wun Kim
Young Tae Kim
Jung-won Yoon
Kyung Jin Eoh
Source :
BMC Cancer, BMC Cancer, Vol 17, Iss 1, Pp 1-7 (2017)
Publication Year :
2017
Publisher :
BioMed Central, 2017.

Abstract

Background This study aimed to evaluate the perioperative outcomes and prognostic impact of the consecutive steps of imaging, frailty assessment, and diagnostic laparoscopy (DLS) in patients with advanced epithelial ovarian cancer (EOC). Methods Patients diagnosed with EOC during 2012–2015 were analyzed retrospectively. Surgical and survival outcomes were compared between three treatment groups: patients without high tumor dissemination (HTD) who underwent primary debulking surgery (PDS group); patients with HTD who underwent DLS (DLS group); and patients with HTD diagnosed by cytological confirmation of malignancy followed by neoadjuvant chemotherapy (NACT group). Results Of 181 patients, 85, 38, and 58 underwent PDS, DLS, and NACT, respectively. Among the 38 consecutive patients who initially underwent DLS, 6 were considered suitable for PDS; the remaining 32 were eligible for NACT followed by interval debulking surgery. The median operative times of debulking surgery in the PDS, DLS, and NACT groups were 365 min (interquartile range [IQR]: 216.5–476.5 min), 266.2 min (IQR: 160.3–193.5 min), and 339.0 min (IQR: 205–425 min; P = 0.042), respectively, with respective median estimated blood loss volumes of 962.2 mL (IQR: 300–1037.5 mL), 267.1 mL (IQR: 150–450 mL), and 861.7 mL (IQR: 150–1200 mL; P = 0.023). The DLS group had significantly reduced transfusion requirements and intensive care unit admission rates (P = 0.006). The Kaplan–Meier survival analysis indicated significantly poor PFS in the NACT group. However, there was no significant difference in OS among the three groups. Conclusions The consecutive steps of imaging, frailty assessment, and DLS might facilitate rapid assessments of peritoneal disease extent and resectability; this novel algorithm might also be used to individualize treatment.

Details

Language :
English
ISSN :
14712407
Volume :
17
Database :
OpenAIRE
Journal :
BMC Cancer
Accession number :
edsair.doi.dedup.....23332916a3b33bba33e8a3bef91126c9