Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications
Abstract Background No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in the...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-11-01
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| Series: | Journal of Ovarian Research |
| Online Access: | https://doi.org/10.1186/s13048-023-01303-1 |
| _version_ | 1797630000556408832 |
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| author | Diederick de Jong Amudha Thangavelu Timothy Broadhead Inga Chen Dermot Burke Richard Hutson Racheal Johnson Angelika Kaufmann Peter Lodge David Nugent Aaron Quyn Georgios Theophilou Alexandros Laios |
| author_facet | Diederick de Jong Amudha Thangavelu Timothy Broadhead Inga Chen Dermot Burke Richard Hutson Racheal Johnson Angelika Kaufmann Peter Lodge David Nugent Aaron Quyn Georgios Theophilou Alexandros Laios |
| author_sort | Diederick de Jong |
| collection | DOAJ |
| description | Abstract Background No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS). Results R0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed. Conclusions Improved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications. |
| first_indexed | 2024-03-11T11:01:51Z |
| format | Article |
| id | doaj.art-0faae19d03ae41fbbd9f6880337ab284 |
| institution | Directory Open Access Journal |
| issn | 1757-2215 |
| language | English |
| last_indexed | 2024-03-11T11:01:51Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Ovarian Research |
| spelling | doaj.art-0faae19d03ae41fbbd9f6880337ab2842023-11-12T12:26:56ZengBMCJournal of Ovarian Research1757-22152023-11-0116111110.1186/s13048-023-01303-1Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramificationsDiederick de Jong0Amudha Thangavelu1Timothy Broadhead2Inga Chen3Dermot Burke4Richard Hutson5Racheal Johnson6Angelika Kaufmann7Peter Lodge8David Nugent9Aaron Quyn10Georgios Theophilou11Alexandros Laios12Department of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Surgery, Colorectal Surgery Service, St. James’s University Hospital LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James’s University Hospital LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Surgery, Hepatobilliary Surgery and Liver Transplant Service, St. James’s University Hospital LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTDepartment of Gynaecological Oncology, ESGO Centre of Excellence in advanced ovarian cancer surgery, St. James’s University Hospital, LTHTAbstract Background No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS). Results R0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed. Conclusions Improved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications.https://doi.org/10.1186/s13048-023-01303-1 |
| spellingShingle | Diederick de Jong Amudha Thangavelu Timothy Broadhead Inga Chen Dermot Burke Richard Hutson Racheal Johnson Angelika Kaufmann Peter Lodge David Nugent Aaron Quyn Georgios Theophilou Alexandros Laios Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications Journal of Ovarian Research |
| title | Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications |
| title_full | Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications |
| title_fullStr | Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications |
| title_full_unstemmed | Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications |
| title_short | Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications |
| title_sort | prerequisites to improve surgical cytoreduction in figo stage iii iv epithelial ovarian cancer and subsequent clinical ramifications |
| url | https://doi.org/10.1186/s13048-023-01303-1 |
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