AbstractThe objective of the research was to estimate early and long-term results of secondary cytoreductive surgery performed for recurrent ovarian cancer with involvement of urinary organs. Materials and methods. The study included 62 patients with recurrent ovarian cancer treated in the Institute of General and Emergency Surgery named after V.T. Zaitsev of the Academy of Medical Sciences of Ukraine during January 2009 – September 2015. Selection criteria for secondary cytoreductive surgery were the following: recurrent ovarian cancer with involvement of the bladder and/or the ureter, no urologic surgery during primary cytoreductive surgery, the ECOG performance status of 0-2. Urological surgery that had been a subject to the analysis was the following: cystoscopy with or without intraoperative urethral stenting, bladder resection, ureterectomy, ureteral reimplantation, cystectomy with further reconstruction. Evaluation criteria included the presence and the level of surgical and postoperative urological complications within 30 days after surgery, relaparatomy rates, postoperative mortality, type of cytoreduction. Long-term results were evaluated through recurrence rates after secondary cytoreductive surgery, median survival, disease-free survival and overall survival.Results. Volumes of performed surgery (excluding urological one) were the following: lymphadenectomy (n=29; 46.7%), bowel resection (n=17; 27.4%), vascular resection (n=4; 6.5%) and others. Minimally invasive urological surgery included urethral stenting (n=6; 9.7%) and cystoscopy (n=13; 20.9%). Bladder resection was performed in 26 (41.9%) cases, cystectomy – in 17 (27.4%) cases. R0 resections were performed in all the cases. Postoperative non-urological complications were observed in 7 (11.2%) patients. Urological complications were found in 9 (14.5%) patients. Postoperative mortality was 3.2%. Recurrence was documented in 7 (11.3%) cases. Median survival was 24 months. Follow-up mortality was 30% (n=18).Conclusions. The results of combined secondary cytoreductive surgery performed for recurrent ovarian cancer with involvement of urinary organs indicate the possibility of en bloc resection of tumor and surrounding organs at acceptable rates of postoperative complications and mortality. Extended combined surgery and even pelvic exenteration are effective in treatment of patients with recurrent ovarian cancer.
National Cancer Institute. Standards of treatment of oncology patients 2017. Available from: http://unci.org.ua/spetsialistam/standarti-diagnostiki-ta-likuvannya/
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 40(2):205-213. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae
Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma: a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer. 1948;1(2):177-183. DOI: https://doi.org/10.1002/1097-0142(194807)1:2<177::AID-CNCR2820010203>3.0.CO;2-A
Berek JS, Howe C, Lagasse LD, Hacker NF. Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA. Gynecol Oncol. 2005;99:153-159. DOI: https://doi.org/10.1016/j.ygyno.2005.05.034
Goldberg JM, Piver MS, Hempling RE Aiduk C, Blumenson L, Recio FO. Improvements in pelvic exenteration: factors responsible for reducing morbidity and mortality. Ann Surg Oncol. 1998;5:399–406. DOI: https://doi.org/10.1007/BF02303857 [PMid:9718168]
Lopez MJ, Standiford SB, Skibba JL. Total pelvic exenteration. A 50-year experience at the Ellis Fischel Cancer Center. Arch Surg 1994;129(4):390-395. DOI: https://doi.org/10.1001/archsurg.1994.01420280062008
Nguyen DQ, McGregor AD, Freites O, Carr ND, Beynon J, El-Sharkawi AM et al. Exenterative pelvic surgery - eleven year experience of the Swansea Pelvic Oncology Group. Eur J Surg Oncol. 2005;31(10):1180-1184. DOI: https://doi.org/10.1016/j.ejso.2005.07.007
Arvas M, Salihoglu Y, Sal V, Gungor T, Sozen H, Kahramanoglu I et al. Tertiary cytoreduction for recurrent epithelial ovarian cancer: a multicenter study in Turkey. Asian Pac J Cancer Prev 2016;17(4):1909-15. DOI: https://doi.org/10.7314/APJCP.2016.17.4.1909 [PMid:27221875]
Fleisch MC, Pantke P, Beckmann MW, Schnuerch HG, Ackermann R, Grimm MO et al. Predictors for long-term survival after interdisciplinary salvage surgery for advanced or recurrent gynecologic cancers. J Surg Oncol. 2007;95(6):476-84. DOI: https://doi.org/10.1002/jso.20686
Minaguchi T, Satoh T, Matsumoto K, Sakurai M, Ochi H, Onuki M et al. Proposal for selection criteria of secondary cytoreductive surgery in recurrent epithelial ovarian, tubal, and peritoneal cancers. Int J Clin Oncol. 2016;21(3):573-9. DOI: https://doi.org/10.1007/s10147-015-0910-8
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.