Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter?
Background Elderly ovarian cancer (OC) patients are more likely to be managed suboptimally, with worse clinical outcomes as a result. Strategies to decrease morbidity are lacking. Methodology: Consecutive patients with advanced stage OC (IIIC-IV) who were managed in our center between January 2016 a...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2021-08-01
|
| Series: | Journal of Investigative Surgery |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08941939.2020.1733146 |
| _version_ | 1797684599608836096 |
|---|---|
| author | Ciro Pinelli Matteo Morotti Jvan Casarin Roberto Tozzi Fabio Ghezzi Vasileios K. Mavroeidis Moiad Alazzam Hooman Soleymani majd |
| author_facet | Ciro Pinelli Matteo Morotti Jvan Casarin Roberto Tozzi Fabio Ghezzi Vasileios K. Mavroeidis Moiad Alazzam Hooman Soleymani majd |
| author_sort | Ciro Pinelli |
| collection | DOAJ |
| description | Background Elderly ovarian cancer (OC) patients are more likely to be managed suboptimally, with worse clinical outcomes as a result. Strategies to decrease morbidity are lacking. Methodology: Consecutive patients with advanced stage OC (IIIC-IV) who were managed in our center between January 2016 and July 2018 were retrospectively analyzed. All patients underwent neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) according to our institution protocol. We divided patients into two groups: Group 1 (age ≥ 70 years) and Group 2 (age < 70 years). The primary outcome of the study was assessment of peri-operative morbidity amongst two groups. Results A total of 153 patients were referred during the study period. 114 patients underwent IDS after NACT (74.5%), 46 in Group 1 and 68 in Group 2. Elderly patients were more likely to receive more than three cycles of NACT prior to IDS compared to younger patients (39% vs. 19%, p = 0.03). Elderly patients were more frequently subjected to Cardiopulmonary Exercise Testing (CPET) as pre-operative assessment (63% vs. 27%, p = 0.002). Optimal/complete resection was achieved in all patients in Group 1 (100%) and in 97% of patients in Group 2. With the exception of higher postoperative cardiac arrhythmias in Group 1 (11% vs. 1%, p = 0.04), no significant differences in 30-day morbidity were observed. No 90-day death in both groups was registered. Conclusion Older age should not preclude clinicians from offering ultra-radical resection to patients with advanced OC after NACT. In our series, elderly patients received the same treatment with similar outcomes to the younger group. Clinicians should be encouraged to use CPET for patients’ selection following NACT. |
| first_indexed | 2024-03-12T00:32:59Z |
| format | Article |
| id | doaj.art-4a35d942639f4c61ab7db3f3fa27a27a |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:32:59Z |
| publishDate | 2021-08-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-4a35d942639f4c61ab7db3f3fa27a27a2023-09-15T10:07:32ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532021-08-013491023103010.1080/08941939.2020.17331461733146Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter?Ciro Pinelli0Matteo Morotti1Jvan Casarin2Roberto Tozzi3Fabio Ghezzi4Vasileios K. Mavroeidis5Moiad Alazzam6Hooman Soleymani majd7Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill HospitalDepartment of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill HospitalDepartment of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill HospitalDepartment of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill HospitalDepartment of Obstetrics and Gynaecology, University of InsubriaDepartment of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Churchill HospitalDepartment of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill HospitalDepartment of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill HospitalBackground Elderly ovarian cancer (OC) patients are more likely to be managed suboptimally, with worse clinical outcomes as a result. Strategies to decrease morbidity are lacking. Methodology: Consecutive patients with advanced stage OC (IIIC-IV) who were managed in our center between January 2016 and July 2018 were retrospectively analyzed. All patients underwent neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) according to our institution protocol. We divided patients into two groups: Group 1 (age ≥ 70 years) and Group 2 (age < 70 years). The primary outcome of the study was assessment of peri-operative morbidity amongst two groups. Results A total of 153 patients were referred during the study period. 114 patients underwent IDS after NACT (74.5%), 46 in Group 1 and 68 in Group 2. Elderly patients were more likely to receive more than three cycles of NACT prior to IDS compared to younger patients (39% vs. 19%, p = 0.03). Elderly patients were more frequently subjected to Cardiopulmonary Exercise Testing (CPET) as pre-operative assessment (63% vs. 27%, p = 0.002). Optimal/complete resection was achieved in all patients in Group 1 (100%) and in 97% of patients in Group 2. With the exception of higher postoperative cardiac arrhythmias in Group 1 (11% vs. 1%, p = 0.04), no significant differences in 30-day morbidity were observed. No 90-day death in both groups was registered. Conclusion Older age should not preclude clinicians from offering ultra-radical resection to patients with advanced OC after NACT. In our series, elderly patients received the same treatment with similar outcomes to the younger group. Clinicians should be encouraged to use CPET for patients’ selection following NACT.http://dx.doi.org/10.1080/08941939.2020.1733146cpetdebulking surgeryelderlyneoadjuvant chemotherapyovarian cancermorbidity |
| spellingShingle | Ciro Pinelli Matteo Morotti Jvan Casarin Roberto Tozzi Fabio Ghezzi Vasileios K. Mavroeidis Moiad Alazzam Hooman Soleymani majd Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter? Journal of Investigative Surgery cpet debulking surgery elderly neoadjuvant chemotherapy ovarian cancer morbidity |
| title | Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter? |
| title_full | Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter? |
| title_fullStr | Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter? |
| title_full_unstemmed | Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter? |
| title_short | Interval Debulking Surgery for Advanced Ovarian Cancer in Elderly Patients (≥70 y): Does the Age Matter? |
| title_sort | interval debulking surgery for advanced ovarian cancer in elderly patients ≥70 y does the age matter |
| topic | cpet debulking surgery elderly neoadjuvant chemotherapy ovarian cancer morbidity |
| url | http://dx.doi.org/10.1080/08941939.2020.1733146 |
| work_keys_str_mv | AT ciropinelli intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT matteomorotti intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT jvancasarin intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT robertotozzi intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT fabioghezzi intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT vasileioskmavroeidis intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT moiadalazzam intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter AT hoomansoleymanimajd intervaldebulkingsurgeryforadvancedovariancancerinelderlypatients70ydoestheagematter |