Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease

An analysis of Gynecologic Oncology Group (GOG) 182

Noah Rodriguez, Austin Miller, Scott D. Richard, Bunja Rungruang, Chad A. Hamilton, Michael A. Bookman, G. Larry Maxwell, Neil S. Horowitz, Thomas C. Krivak

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Purpose To examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival. Patients and methods We reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease < 1 cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan-Meier and proportional hazards methods. Results Four-hundred eighty-two patients (18.1%) underwent a total of 590 UAPs. There were 351 (13.1%) diaphragm surgeries, 112 (4.2%) liver surgeries, 108 (4%) splenectomies, 12 (0.5%) pancreatectomies, and 7 (0.2%) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2 months (mos) and 14.8 mos (p < 0.01) and OS was 49.8 mos v. 43.7 mos (p = 0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR = 1.03, 95% CI 0.91-1.15; OS HR = 0.92, 95%CI 0.81-1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4 mos (p = 0.0005). Conclusions UAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.

Original languageEnglish (US)
Pages (from-to)487-492
Number of pages6
JournalGynecologic Oncology
Volume130
Issue number3
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

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Carcinoma
Pancreatectomy
Splenectomy
Diaphragm
Liver
Residual Neoplasm
Survival Analysis
Demography
Survival
Neoplasms

Keywords

  • Ovarian cancer
  • Surgical debulking
  • Upper abdominal procedures

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease : An analysis of Gynecologic Oncology Group (GOG) 182. / Rodriguez, Noah; Miller, Austin; Richard, Scott D.; Rungruang, Bunja; Hamilton, Chad A.; Bookman, Michael A.; Maxwell, G. Larry; Horowitz, Neil S.; Krivak, Thomas C.

In: Gynecologic Oncology, Vol. 130, No. 3, 01.09.2013, p. 487-492.

Research output: Contribution to journalArticle

Rodriguez, Noah ; Miller, Austin ; Richard, Scott D. ; Rungruang, Bunja ; Hamilton, Chad A. ; Bookman, Michael A. ; Maxwell, G. Larry ; Horowitz, Neil S. ; Krivak, Thomas C. / Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease : An analysis of Gynecologic Oncology Group (GOG) 182. In: Gynecologic Oncology. 2013 ; Vol. 130, No. 3. pp. 487-492.
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abstract = "Purpose To examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival. Patients and methods We reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease < 1 cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan-Meier and proportional hazards methods. Results Four-hundred eighty-two patients (18.1{\%}) underwent a total of 590 UAPs. There were 351 (13.1{\%}) diaphragm surgeries, 112 (4.2{\%}) liver surgeries, 108 (4{\%}) splenectomies, 12 (0.5{\%}) pancreatectomies, and 7 (0.2{\%}) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2 months (mos) and 14.8 mos (p < 0.01) and OS was 49.8 mos v. 43.7 mos (p = 0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR = 1.03, 95{\%} CI 0.91-1.15; OS HR = 0.92, 95{\%}CI 0.81-1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4 mos (p = 0.0005). Conclusions UAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.",
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T2 - An analysis of Gynecologic Oncology Group (GOG) 182

AU - Rodriguez, Noah

AU - Miller, Austin

AU - Richard, Scott D.

AU - Rungruang, Bunja

AU - Hamilton, Chad A.

AU - Bookman, Michael A.

AU - Maxwell, G. Larry

AU - Horowitz, Neil S.

AU - Krivak, Thomas C.

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N2 - Purpose To examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival. Patients and methods We reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease < 1 cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan-Meier and proportional hazards methods. Results Four-hundred eighty-two patients (18.1%) underwent a total of 590 UAPs. There were 351 (13.1%) diaphragm surgeries, 112 (4.2%) liver surgeries, 108 (4%) splenectomies, 12 (0.5%) pancreatectomies, and 7 (0.2%) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2 months (mos) and 14.8 mos (p < 0.01) and OS was 49.8 mos v. 43.7 mos (p = 0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR = 1.03, 95% CI 0.91-1.15; OS HR = 0.92, 95%CI 0.81-1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4 mos (p = 0.0005). Conclusions UAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.

AB - Purpose To examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival. Patients and methods We reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease < 1 cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan-Meier and proportional hazards methods. Results Four-hundred eighty-two patients (18.1%) underwent a total of 590 UAPs. There were 351 (13.1%) diaphragm surgeries, 112 (4.2%) liver surgeries, 108 (4%) splenectomies, 12 (0.5%) pancreatectomies, and 7 (0.2%) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2 months (mos) and 14.8 mos (p < 0.01) and OS was 49.8 mos v. 43.7 mos (p = 0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR = 1.03, 95% CI 0.91-1.15; OS HR = 0.92, 95%CI 0.81-1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4 mos (p = 0.0005). Conclusions UAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.

KW - Ovarian cancer

KW - Surgical debulking

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