Outcomes of extensive surgeries in combination treatment of stage III–IV ovarian cancer

Objective: to evaluate short-term and long-term outcomes of lymph node dissection in patients with stage III–IV ovarian cancer.Materials and methods. This retrospective study included patients with stage III–IV ovarian cancer who have undergone either complete or optimal cytoreduction. Patients in the experimental group additionally had lymph node dissection, whereas patients in the control group had surgery without lymph node dissection. We evaluated 3‑year relapse-free survival (primary outcome measure), 3‑year overall survival, incidence of intraoperative and postoperative complications, and frequency of lymph node lesions.Results. The study included 272 patients: 43 women in the experimental group and 229 women in the control group. Intraoperative complications were significantly more common in patients who had lymph node dissection compared to those who had cytoreductive surgery alone (37.2 % vs 16.6 % respectively; р = 0.0001). The incidence of postoperative complications did not vary significantly between the groups (27.9 % in the experimental group vs 16.2 % in the control group; р = 0.128). Thirty-three patients (76.7 %) were found to have metastasis in the lymph nodes excised. The three-year overall survival rate was 82.6 % among patients who had lymph node dissection and 75.7 % among patients who had no lymph node dissection (р = 0.306). The three-year relapse-free survival rate was 26.2 % in the experimental group and 38.4 % in the control group (р = 0.858).Conclusions. Systemic lymph node dissection does not improve long-term outcomes and increases the incidence of intraoperative complications in patients with stage III–IV ovarian cancer undergoing complete or optimal cytoreduction

Combined and expanded operations in patients with relapsed ovarian cancer and affected retroperitoneal lymph nodes

Objective: to analyze short-term and long-term outcomes of expanded surgeries in patients with recurrent ovarian cancer and to identify factors affecting their overall survival (OS) and progression-free survival (PFS). Materials and methods. This retrospective study included patients with recurrent ovarian cancer stage I–IV less than 80 years of age who was treated in the Department of Gynecologic Oncology, N. N. Blokhin National Medical Research Center of Oncology, between 2015 and 2017. Other inclusion criteria were as follows: time to relapse more than 12 months and no chemotherapy during the last 6 months or more. We analyzed the main perioperative parameters, OS, PFS, and prognostic factors affecting OS and PFS. Results. This study included 55 patients. Of them, 44 (80 %) women have undergone complete cytoreductive surgery, whereas 11 (20 %) women have undergone optimal cytoreductive surgery. The median duration of surgery was 210 minutes (range: 60–390 minutes), median blood loss was 400 mL (range: 30–4500 mL). Postoperative complications were observed in 23 (41.2 %) patients; 5 (9.1 %) patients developed grade IIIB complications. Median follow-up time was 30.3 months (range: 7.5–67.1 months). Three-year OS was 73.7 % and three-year PFS was 30.7 %. More than one line of chemotherapy before repeated cytoreductive surgery was found to be a negative factor affecting OS (hazard ratio 2.749; 95 % confidence interval 1.059–7.138; p = 0.038). The primary ECOG performance status had a significant impact on PFS (hazard ratio 0.543; 95 % confidence interval 0.347–0.851; p = 0.008). Conclusions. Poor ECOG status and more than one line of chemotherapy before repeated cytoreductive surgery for ovarian cancer relapse were demonstrated to have a negative impact on survival in this group of patients. However, in some patients, repeated cytoreductive surgeries ensured long-term remission

Результаты расширенных хирургических вмешательств при комбинированном лечении рака яичников III–IV стадии

Objective: to evaluate short-term and long-term outcomes of lymph node dissection in patients with stage III–IV ovarian cancer.Materials and methods. This retrospective study included patients with stage III–IV ovarian cancer who have undergone either complete or optimal cytoreduction. Patients in the experimental group additionally had lymph node dissection, whereas patients in the control group had surgery without lymph node dissection. We evaluated 3‑year relapse-free survival (primary outcome measure), 3‑year overall survival, incidence of intraoperative and postoperative complications, and frequency of lymph node lesions.Results. The study included 272 patients: 43 women in the experimental group and 229 women in the control group. Intraoperative complications were significantly more common in patients who had lymph node dissection compared to those who had cytoreductive surgery alone (37.2 % vs 16.6 % respectively; р = 0.0001). The incidence of postoperative complications did not vary significantly between the groups (27.9 % in the experimental group vs 16.2 % in the control group; р = 0.128). Thirty-three patients (76.7 %) were found to have metastasis in the lymph nodes excised. The three-year overall survival rate was 82.6 % among patients who had lymph node dissection and 75.7 % among patients who had no lymph node dissection (р = 0.306). The three-year relapse-free survival rate was 26.2 % in the experimental group and 38.4 % in the control group (р = 0.858).Conclusions. Systemic lymph node dissection does not improve long-term outcomes and increases the incidence of intraoperative complications in patients with stage III–IV ovarian cancer undergoing complete or optimal cytoreduction.Цель исследования – изучить непосредственные и отдаленные результаты выполнения лимфодиссекции у больных раком яичников III–IV стадии.Материалы и методы. В ретроспективный анализ включены данные больных раком яичников III–IV стадии, которым была выполнена полная или оптимальная циторедукция. В исследуемой группе дополнительно проводили лимфодиссекцию. Основным оцениваемым параметром была 3‑летняя безрецидивная выживаемость. Дополнительно оценивали 3‑летнюю общую выживаемость, частоту интра- и послеоперационных осложнений, частоту поражения лимфатических узлов.Результаты. В исследуемую группу было включено 272 пациентки: 43 в группу хирургического лечения с лимфодиссекцией и 229 в группу хирургического лечения без лимфодиссекции. Интраоперационные осложнения достоверно чаще отмечены в группе с лимфодиссекцией: у 37,2 % пациенток по сравнению с 16,6 % (р = 0,0001). Частота послеоперационных осложнений достоверно не различалась между исследуемыми группами: 27,9 % в группе с лимфодиссекцией и 16,2 % в контрольной группе (р = 0,128). Поражение метастазами опухоли удаленных лимфатических узлов отмечено у 33 (76,7 %) пациенток. Трехлетняя общая выживаемость составила 82,6 % в группе с лимфодиссекцией и 75,7 % в группе без лимфодиссекции (р = 0,306), 3‑летняя безрецидивная выживаемость – 26,2 % в группе с лимфодиссекцией и 38,4 % в группе без лимфодиссекции (р = 0,858).Выводы. Систематическое выполнение лимфодиссекции не приводит к улучшению отдаленных результатов лечения у больных раком яичников III–IV стадии, которым была проведена полная или оптимальная циторедукция, но служит причиной досто- верного повышения числа интраоперационных осложнений

Комбинированные и расширенные операции при поражении забрюшинных лимфатических узлов у пациенток с рецидивами рака яичников

Objective: to analyze short-term and long-term outcomes of expanded surgeries in patients with recurrent ovarian cancer and to identify factors affecting their overall survival (OS) and progression-free survival (PFS). Materials and methods. This retrospective study included patients with recurrent ovarian cancer stage I–IV less than 80 years of age who was treated in the Department of Gynecologic Oncology, N. N. Blokhin National Medical Research Center of Oncology, between 2015 and 2017. Other inclusion criteria were as follows: time to relapse more than 12 months and no chemotherapy during the last 6 months or more. We analyzed the main perioperative parameters, OS, PFS, and prognostic factors affecting OS and PFS. Results. This study included 55 patients. Of them, 44 (80 %) women have undergone complete cytoreductive surgery, whereas 11 (20 %) women have undergone optimal cytoreductive surgery. The median duration of surgery was 210 minutes (range: 60–390 minutes), median blood loss was 400 mL (range: 30–4500 mL). Postoperative complications were observed in 23 (41.2 %) patients; 5 (9.1 %) patients developed grade IIIB complications. Median follow-up time was 30.3 months (range: 7.5–67.1 months). Three-year OS was 73.7 % and three-year PFS was 30.7 %. More than one line of chemotherapy before repeated cytoreductive surgery was found to be a negative factor affecting OS (hazard ratio 2.749; 95 % confidence interval 1.059–7.138; p = 0.038). The primary ECOG performance status had a significant impact on PFS (hazard ratio 0.543; 95 % confidence interval 0.347–0.851; p = 0.008). Conclusions. Poor ECOG status and more than one line of chemotherapy before repeated cytoreductive surgery for ovarian cancer relapse were demonstrated to have a negative impact on survival in this group of patients. However, in some patients, repeated cytoreductive surgeries ensured long-term remission. Цель исследования – анализ непосредственных и отдаленных результатов расширенных операций у пациенток с рецидивами рака яичников, поиск прогностических факторов общей выживаемости (ОВ) и выживаемости без прогрессирования (ВБП). Материалы и методы. В ретроспективный анализ были включены пациентки в возрасте до 80 лет с рецидивами рака яичников I–IV стадии после предшествующей комбинированной терапии, которым проводилось лечение в отделении онкогинекологии ФГБУ «НМИЦ онкологии им. Н. Н. Блохина» Минздрава России в период с 2015 по 2017 г. Другими критериями включения были безрецидивный период более 12 мес, отсутствие химиотерапии в течение более 6 мес. Анализировались основные периоперационные параметры, ОВ, ВБП, а также прогностические факторы ОВ и ВБП. Результаты. В исследование включены 55 пациенток. Полная циторедукция была выполнена у 44 (80 %) пациенток, оптимальная – у 11 (20 %). Медиана продолжительности операции составила 210 (60–390) мин, медиана кровопотери – 400 (30–4500) мл. Послеоперационные осложнения отмечены у 23 (41,2 %) пациенток, при этом осложнения IIIB степени тяжести – у 5 (9,1 %). Медиана наблюдения составила 30,3 (7,5–67,1) мес, 3-летняя ОВ – 73,7 %, 3-летняя ВБП – 30,7 %. Фактором негативного прогноза ОВ было проведение более 1 линии химиотерапии до повторной операции по поводу рецидива рака яичников (отношение рисков 2,749; 95 % доверительный интервал 1,059–7,138; p = 0,038), фактором прогноза ВБП – исходный функциональный статус по шкале ECOG (отношение рисков 0,543; 95 % доверительный интервал 0,347–0,851; p = 0,008). Выводы. Негативными прогностическими факторами в нашей исследуемой группе были низкий функциональный статус по шкале ECOG и проведение более 1 линии химиотерапии до повторной циторедукции по поводу рецидива рака яичников. У части пациенток повторные циторедуктивные вмешательства позволяют добиться длительной ремиссии заболевания.