The impact of ultra-radical surgery in the management of patients with stage IIIC and IV epithelial ovarian, fallopian tube, and peritoneal cancer.
OBJECTIVE
The aim of this study is to estimate the percentage of patients with metastatic ovarian, fallopian tube, and primary peritoneal cancer requiring ultra-radical surgery to achieve cytoreduction to less than 1 cm (optimal) or no macroscopic residual disease (complete).


METHODS
Perioperative data were collected prospectively on consecutive patients undergoing elective cytoreductive surgery for metastatic epithelial ovarian, fallopian tube, or primary peritoneal cancer at the Norfolk and Norwich University Hospital, a tertiary referral cancer centre in the United Kingdom from November 2012 to June 2016.


RESULTS
Over a 42-month period, 135 consecutive patients underwent cytoreductive surgery for stage IIIC and IV ovarian, fallopian tube, or primary peritoneal cancer. The median age of the patients was 69 years. 47.4% of the patients underwent diaphragmatic peritonectomy and/or resection, 20% underwent splenectomy, 14.1% had excision of disease from porta hepatis and celiac axis, and 5.2% of the patients had gastrectomy. Cytoreduction to no macroscopic visible disease (complete) and to disease with greater tumour diameter of less than 1 cm (optimal) was achieved in 54.1 and 34.1% of the cases, respectively. Without incorporating surgical procedures in the upper abdomen ('ultra-radical'), the combined rate of complete and optimal cytoreduction would be only 33.3%.


CONCLUSIONS
Up to 50.4% of the patients in this study required at least one surgical procedure classified as ultra-radical, emphasizing the importance of cytoreductive surgery in the upper abdomen in management of women with stage IIIC and IV ovarian, fallopian tube, and primary peritoneal cancer.
['Turnbull|Hilary L|HL|http://orcid.org/0000-0002-6669-571X', 'Akrivos|Nikolaos|N|', 'Wemyss-Holden|Simon|S|', 'Maiya|Balachandra|B|', 'Duncan|Timothy J|TJ|', 'Nieto|Joaquin J|JJ|', 'Burbos|Nikolaos|N|']
D000368:Aged D000077216:Carcinoma, Ovarian Epithelial D065426:Cytoreduction Surgical Procedures D005185:Fallopian Tube Neoplasms D005260:Female D006801:Humans D008875:Middle Aged D009367:Neoplasm Staging D009375:Neoplasms, Glandular and Epithelial D010051:Ovarian Neoplasms D010534:Peritoneal Neoplasms
Ultra-radical surgery Cytoreduction Ovarian cancer