SAFETY AND EFFICACY OF CYTOREDUCTIVE SURGERY FOR EPITHELIAL OVARIAN CANCER IN ELDERLY AND COMPLICATED PATIENTS

S. Sharma, D. Driscoll, K. Odunsi, S. Lele

Roswell Park Cancer Institute, Buffalo, NY

OBJECTIVES: Surgery is the cornerstone of management of epithelial ovarian cancer (EOC). Optimal cytoreduction is associated with a significant survival advantage. However in complicated and elderly patients (pts) neoadjuvant chemotherapy has been explored. Experience in cytoreductive procedures has led to improved morbidity and mortality associated with debulking surgery. The aim of this study was to review the experience with cytoreductive surgery for EOC at a major cancer institute, with special focus on complications and outcomes in patients with multiple surgical risk factors.

MATERIALS AND METHODS: Charts of pts with EOC at single cancer institute from 1998-2002 were retrospectively reviewed. Data was collected on the age, medical comorbidities, operative complications, chemotherapy, extent of procedure, residual disease, and clinico-pathological characteristics.

RESULTS: 140 patients were treated for EOC. Median age was 62 years. 63 pts (45%) were elderly (>65 years), 69 pts (49%) had significant medical comorbidities, 60 pts (43%) had previous laparotomies. Procedures were grouped into standard (24%), radical (57%), and supraradical (19%). 112 pts (80%) were advanced stage. Optimal debulking (< 1 cm) was achieved in 123 pts (88%). 52 pts (37%) required transfusions. 15 pts (11%) had major postoperative complications, 5 pts (4%) had long-term complications, and 5 pts (4%) required reexploration within 60 days of initial surgery. There was 1 perioperative death in a patient with liver failure from multiple liver metastasis. Median duration of follow-up was 30 months. There was correlation between type of procedure and need for transfusion (likelihood ratio=5.9, p=0.05). There was no correlation between incidence of postoperative complications and type of procedure, elderly age, medical comorbidities, prior laparotomies, need for transfusion, or stage of disease. Median survival for optimally debulked pts was 52 months vs. 26 months for suboptimally debulked pts (p<0.001).

CONCLUSIONS: Our data demonstrates that aggressive optimal cytoreduction can be achieved in the majority of pts with multiple surgical risk factors and is associated with a low complication rate. Age, medical comorbidities, prior surgical history, and advanced stage should not preclude pts from maximal surgical effort. Optimal cytoreduction continues to be a critical factor in survival.

Key Words: cytoreduction, elderly, complications, ovarian cancer

Disclosure – Nothing to disclose.