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Pathologic distribution at the time of interval tumor reductive surgery informs personalized surgery for high-grade ovarian cancer
  1. Courtney D Bailey1,
  2. Rebecca Previs2,
  3. Bryan M Fellman3,
  4. Tarrik Zaid4,
  5. Marilyn Huang5,
  6. Alaina Brown6,
  7. Ahmed Enbaya4,
  8. Nyla Balakrishnan7,
  9. Russell R Broaddus8,
  10. Diane C Bodurka4,
  11. Pamela Soliman4,
  12. Nicole D Fleming4,
  13. Alpa Nick9,
  14. Anil K Sood4 and
  15. Shannon Neville Westin4
  1. 1 Obstretrics and Gynecology, Division of Gynecologic Oncology, Augusta University Medical College of Georgia, Augusta, Georgia, USA
  2. 2 Obstretrics and Gynecology, Division of Gynecologic Oncology, Duke Cancer Institute, Durham, North Carolina, USA
  3. 3 Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  5. 5 Obstretrics and Gynecology, Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
  6. 6 Obstretrics and Gynecology, Division of Gynecologic Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  7. 7 Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  8. 8 Pathology and Laboratory Medicine, University of North Carolina System, Chapel Hill, North Carolina, USA
  9. 9 Gynecologic Oncology, Tennessee Oncology, Nashville, Tennessee, USA
  1. Correspondence to Dr Shannon Neville Westin, Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; swestin{at}


Introduction The surgical approach for interval debulking surgery after neoadjuvant chemotherapy has been extrapolated from primary tumor reductive surgery for high-grade ovarian cancer. The study objective was to compare pathologic distribution of malignancy at interval debulking surgery versus primary tumor reductive surgery.

Methods Patients with a diagnosis of high-grade serous or mixed, non-mucinous, epithelial ovarian, fallopian tube or primary peritoneal cancer who underwent neoadjuvant chemotherapy or primary tumor reductive surgery and had at least 6 months of follow-up were identified through tumor registry at a single institution from January 1995 to April 2016. Pathologic involvement of organs was categorized as macroscopic, microscopic, or no tumor. Statistical analyses included Mann-Whitney and Fisher’s exact tests.

Results Of 918 patients identified, 366 (39.9%) patients underwent interval debulking surgery and 552 (60.1%) patients underwent primary tumor reductive surgery. Median age was 62.3 years (range 25.3–92.5). The majority of patients in the interval debulking surgery group were unstaged (261, 71.5%). In the patients who had a primary tumor reductive surgery, 406 (74.6%) had stage III disease. In both groups, the majority of patients had serous histology: 325 (90%) and 435 (78.8%) in the interval debulking and primary tumor reductive surgery groups, respectively. There was a statistically significant difference between disease distribution on the uterus between the groups; 31.4% of the patients undergoing interval debulking surgery had no evidence of uterine disease compared with 22.1% of primary tumor reductive surgery specimens (p<0.001). In the adnexa, there was macroscopic disease present in 253 (69.2%) and 482 (87.4%) of cases in the interval vs primary surgery groups, respectively (p<0.001). Within the omentum, no tumor was present in the omentum in 52 (14.2%) in the interval surgery group versus 91 (16.5%) in the primary surgery group (p<0.001). In the interval surgery group, there was no tumor involving the small and large bowel in 49 (13.4%) and 28 (7.7%) pathologic specimens, respectively. This was statistically significantly different from the small and large bowel in the primary surgery group, of which there was no tumor in 20 (3.6%, p<0.001) and 16 (2.9%, p<0.001) of cases, respectively.

Conclusion In patients undergoing interval debulking surgery, there was less macroscopic involvement of tumor in the uterus, adnexa and bowel compared with patients undergoing primary cytoreductive surgery.

  • ovarian cancer
  • gynecologic surgical procedures

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  • Twitter @PamSolimanMD, @nicoleflemingmd, @Shannon.Westin

  • Contributors CDB, RP, SNW: conception, statistical analysis, critical analysis, drafting/final editing. BMF: statistical analysis, critical analysis, drafting/final editing. TZ, MH, AB, AE, NB, RRB, DCB, PTS, NDF, AMN, AKS: critical analysis, drafting/final editing.

  • Funding NIH K12CA088084 K12 Calabresi Scholar Award, NIH 1P50CA217685-01 SPORE in Ovarian Cancer, NIH P30CA016672 MD Anderson Cancer Center Support Grant, Andrew Sabin Family Fellowship GOG Foundation Scholar Investigator Award.

  • Competing interests RP receives research support from Myriad. AKS is a consultant for Merck, and Kiyatec. AKS receives research funding (M-Trap); and is a shareholder (BioPath). SNW is a consultant for AstraZeneca, Circulogene, Clovis Oncology, Eisai, GSK/Tesaro, Merck, Novartis, Pfizer, and Roche/Genentech. SNW receives research support from ArQule, AstraZeneca, Bayer, Clovis Oncology, Cotinga Pharmaceuticals, Novartis, Roche/Genentech, and GSK/Tesaro. All conflicts of interest are not related to the current work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

  • Author note All work was done at MD Anderson Cancer Center.