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Clinical Outcome After Completion Surgery in Patients With Ovarian Cancer: The Charite Experience
  1. Aygun Babayeva, MD*,
  2. Elena Ioana Braicu, MD, PhD*,,
  3. Jacek P. Grabowski, MD,
  4. Khayal Gasimli, MD*,
  5. Rolf Richter, MPH*,,
  6. Mustafa Zelal Muallem, MD and
  7. Jalid Sehouli, MD, PhD*,
  1. *Tumor Bank Ovarian Cancer Network, Berlin, Germany; and
  2. European Competence Center for Ovarian Cancer, Charité Comprehensive Cancer Center, Department of Gynecology, Charité–University Medicine of Berlin, Campus Virchow Clinic.
  1. Address correspondence and reprint requests to Aygun Babayeva, MD, Charite Universitatsmedizin Berlin Campus Virchow-Klinikum, Alex-Wedding str. 3, 10178 Berlin. E-mail: aygunbabayeva888{at}gmail.com.

Abstract

Objective The aim of this study was to estimate surgical outcome and survival benefit after completion surgery.

Methods We evaluated 164 patients with epithelial ovarian cancer who underwent incomplete primary cytoreductive surgery or rather received only staging procedures from January 2000 to December 2014 in outside institutions. Patient-related data were registered in prospective database of Tumor Bank Ovarian Cancer. The outcome analyses were performed for early and advanced stages of ovarian cancer separately.

Results The majority of patients were at the time of completion surgery in advanced stages of disease. From overall 111 advanced epithelial ovarian cancer patients, 74 (66.6%) could be operated macroscopically tumor free, minimal residual disease 1 cm or less was achieved in 15.3% of the cases. Mean overall survival for patients without versus those with any tumor residual was 70 months (95% confidence interval, 61.3–81.5) versus 24.7 months (95% confidence interval, 7.1–42.4; P ⩽ 0.0001). After applying completion surgery, 47 (28.6%) and 12 (6.7%) patients were upstaged in FIGO (International Federation of Gynecology and Obstetrics) IIIC and IV stages, respectively. Upstaging resulted in therapy changes in 10 patients (19%) with assumed FIGO IA stages. Major operative complications were registered in 28.8% of advanced cases, and 30-day mortality reached 1.8%.

Conclusions Recent research has shown that the most profound impact on survivorship occurs when women get proper care from surgeons trained in the latest techniques for treating ovarian cancer. Completion surgery maintained that even after initial incomplete cytoreduction outside of the high specialized units, after applying appropriate surgery techniques macroscopically, disease-free situation is achievable and outcomes are comparable with the results of primary debulking surgery.

  • Ovarian cancer
  • Radical cytoreductive surgery
  • Primary debulking surgery
  • Completion surgery
  • Surgical staging
  • Incomplete cytoreduction

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Footnotes

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

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