ABSTRACT
The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.
Subject(s)
Ovarian Neoplasms/surgery , Peritoneal Neoplasms/surgery , Adenocarcinoma, Clear Cell/drug therapy , Adenocarcinoma, Clear Cell/mortality , Adenocarcinoma, Clear Cell/surgery , Adenocarcinoma, Mucinous/drug therapy , Adenocarcinoma, Mucinous/mortality , Adenocarcinoma, Mucinous/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Papillary/drug therapy , Carcinoma, Papillary/mortality , Carcinoma, Papillary/surgery , Chemotherapy, Adjuvant , Cystadenocarcinoma, Serous/drug therapy , Cystadenocarcinoma, Serous/mortality , Cystadenocarcinoma, Serous/surgery , Female , Hospital Mortality , Humans , Lymphatic Metastasis/pathology , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/mortality , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/mortality , Postoperative Complications/etiology , Postoperative Complications/mortality , Prognosis , Retrospective Studies , Survival Rate , Survivors , Time Factors , Treatment OutcomeABSTRACT
AIM: The peritoneal cancer index (PCI) has been used for the detailed evaluation of the peritoneal spread in tumors of gastrointestinal origin and has been found to be a prognostic indicator of survival. The aim of this study was the identification of the significance of the peritoneal cancer index in advanced ovarian cancer. METHODS: From 1990 to 2001, 60 women, mean age 65+/-10.84 (41-86), were treated for advanced ovarian cancer. The performance status (Karnofsky performance scale), age, prior surgery score (PSS), peritoneal cancer index (PCI), tumor volume, tumor grade, residual tumor, the presence of ascites, treatment with adjuvant chemotherapy, histopathologic subtype and FIGO stage were retrospectively correlated to survival using univariate model of statistical analysis. RESULTS: Hospital mortality and morbidity were 11.7 and 16.7% respectively. The recurrence rate was 23.3%. Overall 5-year survival rate was 41% and mean survival 63+/-8 months. The peritoneal cancer index was related to survival (P=0.0253). The other favorable clinical prognostic indicators of survival were low grade and small volume tumors, treatment with adjuvant chemotherapy and complete cytoreductive surgery (P<0.05). CONCLUSIONS: The peritoneal spread in advanced ovarian cancer can be assessed in detail using the peritoneal cancer index. It is a significant prognostic factor of survival and is useful in identifying subgroups.
