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A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India
*Corresponding author: Dr. Anupama Rajanbabu. anupamashyam@gmail.com
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Objectives: The objective was to compare perioperative morbidity and mortality of patients with advanced epithelial ovarian cancer (EOC) treated with either of the two treatment approaches; neoadjuvant chemotherapy (NACT) followed by interval debulking versus upfront surgery. Design: Prospective comparative observational study. Participants: In total, 51 patients were included in the study. All patients with diagnosed advanced EOC (International Federation of Gynecology and Obstetrics IIIC and IV) presenting for the 1st time were included in the study. Interventions: Patients were either operated upfront (n = 19) if deemed operable or were subjected to NACT followed by interval debulking (n = 32). Primary and Secondary Outcomes: Intra- and postoperative morbidity and mortality were the primary outcome measures. Results: Patients with interval cytoreduction were noted to have significantly lesser operative time, blood loss, and extent of surgery. Their discharge time was also significantly earlier. However, they did not differ from the other group vis. a vis. postoperative complications or mortality. Conclusions: Neoadjuvant chemotherapy although has a positive impact on various intraoperative adverse events, fails to show any impact on immediate postoperative negative outcomes.
Keywords
Acknowledgment
Mr. Sundaram and Ms. Amrutha of Department of Biostatistics of Amrita School of Medicine, Kochi, Kerala, India. Dr. K Chitrathara, Dr. Shekhar Sharma, Dr. Santhosh Kuriakose, Dr. Tejal Gorasia and Dr. Dhiraj Khadakban of Department of Surgical Oncology at Amrita Institute of Medical Sciences.
References
- Wey JP, Sellers TA. Epidemiology of ovarian cancer. Methods Mol Biol 2009;472:413-37.
- Cannistra SA. Cancer of the ovary. N Engl J Med 2004;351:2519-29.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40(5):373-83.
- Aletti GD, Santillan A, Eisenhauer EL, Hu J, Aletti G, Podratz KC, et al. A new frontier for quality of care in gynecologic oncology surgery: Multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. Gynecol Oncol 2007;107:99-106.
- Pectasides D, Farmakis D, Koumarianou A. The role of neoadjuvant chemotherapy in the treatment of advanced ovarian cancer. Oncology 2005;68:64-70.
- Pecorelli S, Favalli G, Zigliani L, Odicino F. Cancer in women. Int J Gynaecol Obstet 2003;82:369-79.
- Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975;42:101-4.
- Covens AL. A critique of surgical cytoreduction in advanced ovarian cancer. Gynecol Oncol 2000;78:269-74.
- Chi DS, Zivanovic O, Levinson KL, Kolev V, Huh J, Dottino J et al. The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas. Gynecol Oncol 2010;119(1):38-42.
- Bristow RE, Eisenhauer EL, Santillan A, Chi DS. Delaying the primary surgical effort for advanced ovarian cancer: A systematic review o f neoadjuvant chemotherapy and interval cytoreduction. Gynecol Oncol 2007;104:480-90.
- Schwartz PE, Rutherford TJ, Chambers JT, Kohorn El, Thiel RP. Neoadjuvant chemotherapy for advanced ovarian cancer: Long-term survival. Gynecol Oncol 1999;72(1):93-9.
- Hegazy MA, Hegazi RA, Elshafei MA, Setit AE, Elshamy MR, Eltatoongy M, et al. Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma. World J Surg Oncol 2005;3:57.
- Hou JY, Kelly MG, Yu H, McAlpine JN, Azodi M, Rutherford TJ, et al. Neoadjuvant chemotherapy lessens surgical morbidity in advanced ovarian cancer and leads to improved survival in stage IV disease. Gynecol Oncol 2007;105:211-7.
- Morice P, Dubernard G, Rey A, Atallah D, Pautier P, Pomel C, et al. Results of interval debulking surgery compared with primary debulking surgery in advanced stage ovarian cancer. J Am Coll Surg 2003;197:955-63.
- Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, et al. Aggressive surgical strategies in advanced ovarian cancer: A monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 2009;35:135-43.
- Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943-53.