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Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy.

Publication ,  Journal Article
Davidson, BA; Broadwater, G; Crim, A; Boccacio, R; Bixel, K; Backes, F; Previs, RA; Salinaro, J; Salani, R; Moore, K; Secord, AA
Published in: Gynecol Oncol
March 2019

OBJECTIVES: To evaluate surgical complexity scores (SCS) and minimally invasive surgery (MIS) at interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients receiving neoadjuvant chemotherapy (NACT). METHODS: A multi-institutional study of NACT with IDS for advanced EOC was conducted. Demographic data were abstracted and SCS assigned based on IDS findings. Disease-specific overall survival (DSS) was defined as the time from completion of adjuvant chemotherapy to death due to disease. Cox proportional hazards regression models were used for univariate and multivariate survival analyses. RESULTS: 282 patients were identified; 80.5% had high-grade serous histology and 54.6% were <75 (median 63.9; range 34.1-84.8). Approximately 84% were optimally cytoreduced (61% R0; 23% <1 cm). In multivariate analyses, age 75+ (p ≤ 0.001), residual disease (>1 cm; p = 0.03), and SCS ≥ 3 (p = 0.04) were significantly predictive of worse DSS when morbidity and ASA score were also in the model. When optimally debulked was defined as R0, only age 75+ (<0.001) was significantly associated with decreased DSS. In the R0 cohort, SCS did not significantly predict DSS. However, subset analysis defining optimal ≤1 cm, revealed higher SCS was associated with a 1.6-fold increased risk of death (p = 0.02). Fifty-one patients underwent laparoscopic IDS. Twenty-four (47%) were converted to laparotomy to achieve optimal debulking in 21 patients (87.5%); while 25 had laparoscopic optimal cytoreduction (19/25 [76%] R0). CONCLUSIONS: In women with advanced EOC treated with NACT, older age, SCS ≥ 3, and residual disease >1 cm at IDS were predictors of worse survival. MIS appears safe and feasible with acceptable optimal cytoreduction rates.

Duke Scholars

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

March 2019

Volume

152

Issue

3

Start / End Page

554 / 559

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Prognosis
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
  • Laparoscopy
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Davidson, B. A., Broadwater, G., Crim, A., Boccacio, R., Bixel, K., Backes, F., … Secord, A. A. (2019). Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol, 152(3), 554–559. https://doi.org/10.1016/j.ygyno.2018.12.011
Davidson, Brittany A., Gloria Broadwater, Aleia Crim, Robert Boccacio, Kristin Bixel, Floor Backes, Rebecca A. Previs, et al. “Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy.Gynecol Oncol 152, no. 3 (March 2019): 554–59. https://doi.org/10.1016/j.ygyno.2018.12.011.
Davidson BA, Broadwater G, Crim A, Boccacio R, Bixel K, Backes F, et al. Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2019 Mar;152(3):554–9.
Davidson, Brittany A., et al. “Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy.Gynecol Oncol, vol. 152, no. 3, Mar. 2019, pp. 554–59. Pubmed, doi:10.1016/j.ygyno.2018.12.011.
Davidson BA, Broadwater G, Crim A, Boccacio R, Bixel K, Backes F, Previs RA, Salinaro J, Salani R, Moore K, Secord AA. Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2019 Mar;152(3):554–559.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

March 2019

Volume

152

Issue

3

Start / End Page

554 / 559

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Prognosis
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
  • Laparoscopy
  • Humans