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Optimization of surgical treatment of advanced ovarian cancer: a Spanish expert perspective

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Abstract

Background

Optimal upfront treatment of patients with advanced ovarian cancer is complex and requires the adequate function of a multidisciplinary team. Specific standard of quality of care needs to be taken into consideration.

Methods

A literature search in PubMed was performed using the following criteria: (“ovarian neoplasms”[MeSH Terms] OR (“ovarian”[All Fields] AND “neoplasms”[All Fields]) OR “ovarian neoplasms”[All Fields] OR (“ovarian”[All Fields] AND “cancer”[All Fields]) OR “ovarian cancer”[All Fields])“[Date - Publication]: “2018/01/14”[Date - Publication]).

Results

This article describes how to optimize the surgical management of advanced ovarian cancer, to achieve the best results in terms of survival and quality of life. For this purpose, this document will cover aspects related to pre-, intra- and postoperative care of newly diagnosed advanced ovarian cancer patients.

Conclusion

Optimizing upfront treatment of patients with advanced ovarian cancer is complex and requires a structured quality management program including the wise judgment of a multidisciplinary team. Surgeries performed by gynecologic oncologists with formal training in cytoreductive techniques at referral centers are crucial factors to obtain better clinical and oncological outcomes. However, other factors such as the patient’s clinical status, the hospital infrastructure and equipment, as well as the tumor biology of each individual patient should also be taken into account before deciding on an initial therapeutic strategy for advanced-stage ovarian cancer to offer patients the best quality of care.

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References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403.

    Article  CAS  Google Scholar 

  2. Lataifeh I, Marsden DE, Robertson G, Gebski V, Hacker NF. Presenting symptoms of epithelial ovarian cancer. Aust N Z J Obstet Gynaecol. 2005;45(3):211–4.

    Article  Google Scholar 

  3. Querleu D, Planchamp F, Chiva L, Fotopoulou C, Barton D, Cibula D, et al. European society of gynaecologic oncology quality indicators for advanced ovarian cancer surgery. Int J Gynecol Cancer. 2016;26(7):1354–63.

    Article  Google Scholar 

  4. du Bois A, Rochon J, Pfisterer J, Hoskins WJ. Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: a systematic review. Gynecol Oncol. 2009;112(2):422–36.

    Article  Google Scholar 

  5. Fung-Kee-Fung M, Kennedy EB, Biagi J, Colgan T, D’Souza D, Elit LM, et al. The optimal organization of gynecologic oncology services: a systematic review. Curr Oncol. 2015;22(4):e282–93.

    Article  CAS  Google Scholar 

  6. Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Gynecol Oncol. 2016;143(1):3–15.

    Article  Google Scholar 

  7. Verleye L, Ottevanger PB, van der Graaf W, Reed NS, Vergote I, Gynaecological Cancer Group of European Organisation for R, et al. EORTC-GCG process quality indicators for ovarian cancer surgery. Eur J Cancer. 2009;45(4):517–26.

  8. Bristow RE, Chang J, Ziogas A, Campos B, Chavez LR, Anton-Culver H. Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines. Obstet Gynecol. 2015;125(4):833–42.

    Article  Google Scholar 

  9. Chi DS, Zivanovic O, Levinson KL, Kolev V, Huh J, Dottino J, et al. The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas. Gynecol Oncol. 2010;119(1):38–42.

    Article  Google Scholar 

  10. Fagotti A, Ferrandina G, Vizzielli G, Fanfani F, Gallotta V, Chiantera V, et al. Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): final analysis of peri-operative outcome. Eur J Cancer. 2016;59:22–33.

    Article  Google Scholar 

  11. Thrall MM, Goff BA, Symons RG, Flum DR, Gray HJ. Thirty-day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly. Obstet Gynecol. 2011;118(3):537–47.

    Article  Google Scholar 

  12. Aletti GD, Eisenhauer EL, Santillan A, Axtell A, Aletti G, Holschneider C, et al. Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol. 2011;120(1):23–8.

    Article  Google Scholar 

  13. du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115(6):1234–44.

    Article  Google Scholar 

  14. Winter WE 3rd, Maxwell GL, Tian C, Carlson JW, Ozols RF, Rose PG, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25(24):3621–7.

    Article  Google Scholar 

  15. Sorensen SS, Mosgaard BJ. Combination of cancer antigen 125 and carcinoembryonic antigen can improve ovarian cancer diagnosis. Dan Med Bull. 2011;58(11):A4331.

    PubMed  Google Scholar 

  16. Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, et al. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG. 2015;122(6):843–9.

    Article  CAS  Google Scholar 

  17. Ferrandina G, Sallustio G, Fagotti A, Vizzielli G, Paglia A, Cucci E, et al. Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial. Br J Cancer. 2009;101(7):1066–73.

    Article  CAS  Google Scholar 

  18. Rutten MJ, van de Vrie R, Bruining A, Spijkerboer AM, Mol BW, Kenter GG, et al. Predicting surgical outcome in patients with International Federation of Gynecology and Obstetrics stage III or IV ovarian cancer using computed tomography: a systematic review of prediction models. Int J Gynecol Cancer. 2015;25(3):407–15.

    Article  Google Scholar 

  19. Suppiah S, Chang WL, Hassan HA, Kaewput C, Asri AAA, Saad FFA, et al. Systematic review on the accuracy of positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging in the management of ovarian cancer: is functional information really needed? World J Nucl Med. 2017;16(3):176–85.

    Article  Google Scholar 

  20. Low RN, Barone RM. Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol. 2012;19(5):1394–401.

    Article  Google Scholar 

  21. Espada M, Garcia-Flores JR, Jimenez M, Alvarez-Moreno E, De Haro M, Gonzalez-Cortijo L, et al. Diffusion-weighted magnetic resonance imaging evaluation of intra-abdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma. Eur Radiol. 2013;23(9):2636–42.

    Article  Google Scholar 

  22. Michielsen K, Vergote I, Op de Beeck K, Amant F, Leunen K, Moerman P, et al. Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol. 2014;24(4):889–901.

  23. Di Guilmi J, Salvo G, Mehran R, Sood AK, Coleman RL, Lu KH, et al. Role of video-assisted thoracoscopy in advanced ovarian cancer: a literature review. Int J Gynecol Cancer. 2016;26(4):801–6.

    Article  Google Scholar 

  24. Deffieux X, Castaigne D, Pomel C. Role of laparoscopy to evaluate candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16(Suppl 1):35–40.

    Article  Google Scholar 

  25. Fagotti A, Vizzielli G, De Iaco P, Surico D, Buda A, Mandato VD, et al. A multicentric trial (Olympia-MITO 13) on the accuracy of laparoscopy to assess peritoneal spread in ovarian cancer. Am J Obstet Gynecol. 2013;209(5):462 e1–e11.

  26. Rutten MJ, van Meurs HS, van de Vrie R, Gaarenstroom KN, Naaktgeboren CA, van Gorp T, et al. Laparoscopy to predict the result of primary cytoreductive surgery in patients with advanced ovarian cancer: a randomized controlled trial. J Clin Oncol. 2017;35(6):613–21.

    Article  Google Scholar 

  27. Vergote I, du Bois A, Amant F, Heitz F, Leunen K, Harter P. Neoadjuvant chemotherapy in advanced ovarian cancer: on what do we agree and disagree? Gynecol Oncol. 2013;128(1):6–11.

    Article  Google Scholar 

  28. Bristow RE, Chang J, Ziogas A, Anton-Culver H, Vieira VM. Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status. Gynecol Oncol. 2014;134(1):60–7.

    Article  Google Scholar 

  29. Bristow RE, Chang J, Ziogas A, Randall LM, Anton-Culver H. High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease. Gynecol Oncol. 2014;132(2):403–10.

    Article  Google Scholar 

  30. Aune G, Torp SH, Syversen U, Hagen B, Tingulstad S. Ten years’ experience with centralized surgery of ovarian cancer in one health region in Norway. Int J Gynecol Cancer. 2012;22(2):226–31.

    Article  Google Scholar 

  31. Robinson WR, Ritter J, Rogers AS, Tedjarati S, Lieberenz C. Clinical trial participation is associated with improved outcome in women with ovarian cancer. Int J Gynecol Cancer. 2009;19(1):124–8.

    Article  Google Scholar 

  32. Bristow RE, Palis BE, Chi DS, Cliby WA. The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol. 2010;118(3):262–7.

    Article  Google Scholar 

  33. European Society of Gynaecological Oncology. ESGO Ovarian Cancer OPERATIVE REPORT. October 2016; https://www.esgo.org/wp-content/uploads/2016/10/ESGO-Operative-Report.pdf.

  34. Marth C, Hiebl S, Oberaigner W, Winter R, Leodolter S, Sevelda P. Influence of department volume on survival for ovarian cancer: results from a prospective quality assurance program of the Austrian Association for Gynecologic Oncology. Int J Gynecol Cancer. 2009;19(1):94–102.

    Article  Google Scholar 

  35. Vernooij F, Heintz AP, Witteveen PO, van der Heiden-van der Loo M, Coebergh JW, van der Graaf Y. Specialized care and survival of ovarian cancer patients in The Netherlands: nationwide cohort study. J Natl Cancer Inst. 2008;100(6):399–406.

  36. Tingulstad S, Skjeldestad FE, Hagen B. The effect of centralization of primary surgery on survival in ovarian cancer patients. Obstet Gynecol. 2003;102(3):499–505.

    PubMed  Google Scholar 

  37. Dahm-Kahler P, Palmqvist C, Staf C, Holmberg E, Johannesson L. Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival—a population-based cohort study. Gynecol Oncol. 2016;142(2):211–6.

    Article  Google Scholar 

  38. Eggink FA, Mom CH, Kruitwagen RF, Reyners AK, Van Driel WJ, Massuger LF, et al. Improved outcomes due to changes in organization of care for patients with ovarian cancer in the Netherlands. Gynecol Oncol. 2016;141(3):524–30.

    Article  CAS  Google Scholar 

  39. Greving JP, Vernooij F, Heintz AP, van der Graaf Y, Buskens E. Is centralization of ovarian cancer care warranted? A cost-effectiveness analysis. Gynecol Oncol. 2009;113(1):68–74.

    Article  Google Scholar 

  40. Bristow RE, Santillan A, Diaz-Montes TP, Gardner GJ, Giuntoli RL 2nd, Meisner BC, et al. Centralization of care for patients with advanced-stage ovarian cancer: a cost-effectiveness analysis. Cancer. 2007;109(8):1513–22.

    Article  Google Scholar 

  41. Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS(R)) society recommendations—Part I. Gynecol Oncol. 2016;140(2):313–22.

    Article  CAS  Google Scholar 

  42. Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for postoperative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS(R)) society recommendations–Part II. Gynecol Oncol. 2016;140(2):323–32.

    Article  CAS  Google Scholar 

  43. Socias MC, Perez-Benavente MA, Sanchez-Iglesias JL, Manrique-Munoz S, Burgos-Pelaez R, Pamies-Serrano M, et al. PROFAST: eRAS in advanced ovarian cancer, a randomised trial. Clin Nutr ESPEN. 2016;12:e48–9.

    Article  Google Scholar 

  44. Lakhman Y, Akin O, Sohn MJ, Zheng J, Moskowitz CS, Iyer RB, et al. Early postoperative CT as a prognostic biomarker in patients with advanced ovarian, tubal, and primary peritoneal cancer deemed optimally debulked at primary cytoreductive surgery. AJR Am J Roentgenol. 2012;198(6):1453–9.

    Article  Google Scholar 

  45. Lorusso D, Sarno I, Di Donato V, Palazzo A, Torrisi E, Pala L, et al. Is postoperative computed tomography evaluation a prognostic indicator in patients with optimally debulked advanced ovarian cancer? Oncology. 2014;87(5):293–9.

    Article  Google Scholar 

  46. Burger IA, Goldman DA, Vargas HA, Kattan MW, Yu C, Kou L, et al. Incorporation of postoperative CT data into clinical models to predict 5-year overall and recurrence free survival after primary cytoreductive surgery for advanced ovarian cancer. Gynecol Oncol. 2015;138(3):554–9.

    Article  Google Scholar 

  47. Chi DS, Ramirez PT, Teitcher JB, Mironov S, Sarasohn DM, Iyer RB, et al. Prospective study of the correlation between postoperative computed tomography scan and primary surgeon assessment in patients with advanced ovarian, tubal, and peritoneal carcinoma reported to have undergone primary surgical cytoreduction to residual disease 1 cm or less. J Clin Oncol. 2007;25(31):4946–51.

    Article  Google Scholar 

  48. Heitz F, Harter P, Avall-Lundqvist E, Reuss A, Pautier P, Cormio G, et al. The prognostic value of tumor residuals indicated by surgeon, by radiology or an integrated approach by surgeons’ assessment and pre-chemotherapy CT-scan in patients with advanced ovarian cancer: An exploratory analysis of the AGO Study led Intergroup trial AGO-OVAR 12. J Clin Oncol. 2017;35(15_suppl):5521.

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Authors and Affiliations

  1. Department of Gynecology, CEU Cardenal Herrera University, Ramon y Cajal s/n, 46115, Valencia, Valencia, Spain

    L. Minig

  2. Department of Gynecology, MD Anderson Cancer Center, Madrid, Spain

    J. de Santiago

  3. Department of Obstetrics and Gynecology, Hospital Politécnico La Fe, Valencia, Spain

    S. Domingo

  4. Department of Obstetrics and Gynecology, Hospital Vall d´Hebron, Barcelona, Spain

    A. Gil-Moreno

  5. Department of Obstetrics and Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

    S. Martínez

  6. Medical Department and Strategy, Roche Pharma, Madrid, Spain

    A. Rodríguez-Garzotto

  7. Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Madrid, Spain

    L. Chiva

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  1. L. Minig
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  2. J. de Santiago
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  3. S. Domingo
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  4. A. Gil-Moreno
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  7. L. Chiva
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Correspondence to L. Minig.

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Minig, L., de Santiago, J., Domingo, S. et al. Optimization of surgical treatment of advanced ovarian cancer: a Spanish expert perspective. Clin Transl Oncol 21, 656–664 (2019). https://doi.org/10.1007/s12094-018-1967-4

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  • DOI: https://doi.org/10.1007/s12094-018-1967-4

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