Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced XXXX .

@entity43 @entity1 @entity5 @entity189 @entity204
BACKGROUND: @entity43 is the sixth most common @entity5 among @entity1 and the leading cause of @entity204 in @entity1 with @entity5 . Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in @entity43 treatment.   OBJECTIVES: To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of @entity43 . SEARCH STRATEGY: We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult @entity1 with advanced primary @entity43 . DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed. MAIN RESULTS: One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 @entity1 with stage IIIC advanced @entity43 who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among @entity1 receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 @entity1 with @entity189 , those who underwent ultra-radical surgery had significantly better disease specific survival than @entity1 who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias. AUTHORS' CONCLUSIONS: We found only low quality evidence comparing ultra-radical and standard surgery in @entity1 with advanced @entity43 and @entity189 . The evidence suggested that ultra-radical surgery may result in better survival.   It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery.In order to determine the role of ultra-radical surgery in the management of @entity43 , a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would be required.
