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LiFE re
Literature for ENYGO
Surgical treatment of primary ovarian fallopian tube and peritoneal cancer
Editor Kristina Lindemann, Michael J. Halaska, Kamil Zalewski
Descriptive summary
Staging
This retrospective study from the Mayo Clinic Tumor Registry, on long-
term survival in 116 node-positive OC, confirmed stage of disease and
residual disease to be the most important prognostic factors. This is in
line with results on short-term survival because events tend to happen
early in follow-up and long-term survivors often are without evidence of
disease [1].
Mueller et al. retrospectively reported on LN metastasis identified in
clear cell carcinoma confined to the ovary [2]. Of 145 staged patients
(>10 LN removed) only 7 (4.8 %) had LN metastasis; 6 of these cases (4.1
%) were isolated metastasis. The highest risk was observed in patients
with positive washings and ovarian surface involvement. This confirms
data from a much larger case series (Mahdi et al., 2013). These findings
may help in the counselling of patients with apparent early-stage dis-
ease, but are not suitable to reconsider staging guidelines.
A retrospective analysis of the validated Tumour Bank Ovarian Cancer
Network Database confirmed the prognostic differences in FIGO stage
III OC as captured in the revised classification [3]. Patients with lymph
node (LN) only involvement had superior survival compared to patients
with peritoneal spread. Differences between groups by localisation of
involved nodes were not statistically significant, probably due to small
numbers.
HIPEC
Several reviews analysed the evidence of HIPEC in the management of
OC; also, its current investigation in recurrent disease (https://clinicaltri- extensive upper abdominal surgery—if tumour reduction resulted in nil
als.gov/ct2/show/NCT01767675) is summarised [4,5,7,8]. A retrospec-
tive study reports long-term survival in 218 primary or recurrent ovarian
cancer patients treated with cytoreductive surgery and HIPEC (paclitaxel)
[6]. All stage IV patients had received 4-8 cycles of neoadjuvant chemo-
therapy. The median overall survival (OS) was 57 months. The overall
morbidity was 34.9 %, Dindo-Clavien III or IV morbidity 13.8 %, the
reoperation rate was 6.9 %, and a mortality rate of 1.4 % was reported.
The debate becomes more interesting when adding the statement paper
by the AGO [9] and the previously published review by Chiva et al. (A
critical appraisal of hyperthermic intraperitoneal chemotherapy (HIPEC)
in the treatment of advanced and recurrent ovarian cancer; Gynecol
Oncol; 2015). Both papers argue that HIPEC remains experimental and
should not be offered outside a clinical trial.
Continued on the next page 
International Journal of Gynecological Cancer, Volume 26, Supplement #1
OVARIAN CANCER
Interval debulking
The Cochrane review on the role of interval debulking surgery in
advanced epithelial OC was recently updated and included three
randomised trials [10]. The authors could still not conclude on the benefit
of interval debulking compared to upfront surgery followed by chemo-
therapy. The studies may mainly present results from populations in
which surgical effort was not sufficiently extensive or surgery was not
performed by gynaeoncologists.
Some correspondence and comments on the CHORUS trial on the same
question of primary chemotherapy versus primary surgery for OC [11-12]
have been published.
Surgical treatment, general
A retrospective analysis of OC patients with FIGO stage IIIC-IV who had
diaphragmatic surgery with either diaphragmatic peritoneal stripping
(DPS) or full thickness resection (FTR), including pleurectomy, showed
similar overall and specific morbidity after both procedures. Diaphrag-
matic involvement extends to the muscle in almost 30 % of the patients
and to the pleura in 20 % [13]. Bogani et al. conducted a systematic
review on the surgical techniques of diaphragm resection during cytore-
duction [14]. The authors confirmed that both DPS and diaphragmatic
FTR for OC are associated with low pulmonary complication and chest
tube placement rates.
Ataseven et al. retrospectively analysed 326 patients with FIGO IV OC, of
which 286 cases underwent surgical debulking. 41 % of the patients had
Stage IV due to pleural effusions/involvement. Patients with FIGO stage
IV disease did benefit from debulking surgery—even in the case of
or < 10 mm residual tumour. The OS observed in patients with complete
macroscopic tumour reduction was 50 months (95 % CI = 3–57 months).
Of note, patients undergoing debulking surgery with postoperative
residual disease >10 mm had a comparable prognosis to patients who
did not undergo debulking surgery. According to the authors, upfront
chemotherapy may be more beneficial in these patients [15].
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