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Digestive resections in advanced-stage ovarian cancer

Nicolae Bacalbasa ()
Olivia Ionescu ()
Paris Ionescu ()
Irina Balescu ()


The standard frontline treatment for advanced-stage ovarian cancer (ASOC) consists of maximal cytoreduction surgery associated with platinum/paclitaxel-based chemotherapy. Several studies have proven that patients with no gross residual disease (RD) have better survival rates than those with optimal but visible RD (RD ≤1 cm). In order to achieve this, more radical cytoreductive procedures such as radical pelvic resection and extensive upper abdominal procedures are performed. However, some investigators have suggested that, although effective, radical surgery cannot fully compensate tumor biology, which is a major determinant in survival and in turn influences the likelihood of surgical cytoreduction. The aim of this review was to present the procedures defining ultra-radical (extensive) surgery and to evaluate its feasibility and morbidity in the management of ASOC.


ovarian cancer; residual disease; cytoreductive surgery

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Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61(2): 69–90. doi: 10.3322/caac.20107.

Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61(4): 212–236. doi: 10.3322/caac.20121.

Shih KK, Chi DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol 2010; 21(2): 75–80. doi: 10.3802/jgo.2010.21.2.75.

Ozols RF. Treatment goals in ovarian cancer. Int J Gynecol Cancer 2005; 15(S1): 3–11.doi: 10.1111/j.1525-1438.2005.15351.x.

Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope RC, Wilson TO, Podratz KC, Cliby WA. Quality improvement in the surgical approach to advanced ovarian cancer: The Mayo Clinic experience. J Am Coll Surg 2009; 208(4): 614–620.doi: 10.1016/j.jamcollsurg.2009.01.006.

Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Poynor EA, Aghajanian C, Jarnagin WR, DeMatteo RP, D’Angelica MI, Barakat RR, Chi DS. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction im-proves survival in patients with stages IIIC–IV epithelial ovarian cancer. Gynecol Oncol 2006; 103(3): 1083–1090. doi: 10.1016/j.ygyno.2006.06.028.

Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, Ball H, Berek JS. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 1994; 170(4): 974–979. doi: 10.1016/S0002-9378(94)70090-7.

Bristow RE, Montz FJ, Lagasse LD, Leuchter RS, Karlan BY. Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol 1999; 72(3): 278–287. doi: 10.1006/gyno.1998.5145.

Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR, Sonoda Y, Levine DA, Hensley M, Barakat RR. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol 2006; 103(2): 559–564. doi: 10.1016/j.ygyno.2006.03.051.

Jaeger W, Ackermann S, Kessler H, Katalinic A, Lang D. The effect of bowel resection on survival in advanced epithelial ovarian cancer. Gynecol Oncol 2001; 83(2): 286–291. doi: 10.1006/gyno.2001.6375.

Merideth MA, Cliby WA, Keeney GL, Lesnick TG, Nagorney DM, Podratz KC. Hepatic resection for metachronous metastases from ovarian carcinoma. Gynecol Oncol 2003; 89(1): 16–21. doi: 10.1016/S0090-8258(03)00004-0.

Pomel C, Dauplat J. Prise en charge chirurgicale des tumeurs épithéliales malignes de l’ovaire (French) [Management of malignant epithelial tumors of the ovary]. J Chir (Paris) 2004; 141(5): 277–284.doi: 10.1016/S0021-7697(04)95334-3.

Eisenkop SM, Spirtos NM, Friedman RL, Lin WC, Pisani AL, Perticucci S. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: A prospective study. Gynecol Oncol 2003; 90(2): 390–396. doi: 10.1016/S0090-8258(03)00278-6.

Eisenkop SM, Spirtos NM. Procedures required to accomplish complete cytoreduction of ovarian cancer: Is there a correlation with “biological aggressiveness” and survival? Gynecol Oncol 2001; 82(3): 435–441.doi: 10.1006/gyno.2001.6313.

Obermair A, Hagenauer S, Tamandl D, Clayton RD, Nicklin JL, Perrin LC, Ward BG, Crandon AJ. Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer. Gynecol Oncol 2001; 83(1): 115–120. doi: 10.1006/gyno.2001.6353.

Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, Gourgou S, Rouanet P. Aggressive surgical strategies in advanced ovarian cancer: A monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 2009; 35(2): 135–143. doi: 10.1016/j.ejso.2008.01.005.

Gouy S, Chereau E, Custodio AS, Uzan C, Pautier P, Haie-Meder C, Duvillard P, Morice P. Surgical procedures and morbidities of diaphragmatic surgery in patients undergoing initial or interval debulking surgery for advanced-stage ovarian cancer. J Am Coll Surg 2010; 210(4): 509–514. doi: 10.1016/j.jamcollsurg.2010.01.011.

Song YJ, Lim MC, Kang S, Seo SS, Kim SH, Han SS, Park SY. Extended cytoreduction of tumor at the porta hepatis by an interdisciplinary team approach in patients with epithelial ovarian cancer. Gynecol Oncol 2011; 121(2): 253–257. doi: 10.1016/j.ygyno.2010.12.350.

Chi DS, Eisenhauer EL, Zivanovic O, Sonoda Y, Abu-Rustum NR, Levine DA, Guile MW, Bristow RE, Aghajanian C, Barakat RR. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol 2009; 114(1): 26–31. doi: 10.1016/j.ygyno.2009.03.018.

Harter P, Muallem ZM, Buhrmann C, Lorenz D, Kaub C, Hils R, Kommoss S, Heitz F, Traut A, du Bois A. Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. Gynecol Oncol 2011; 121(3): 615–619. doi: 10.1016/j.ygyno.2011.02.014.

Soper JT, Couchman G, Berchuck A, Clarke-Pearson D. The role of partial sigmoid colectomy for debulking epithelial ovarian carcinoma. Gynecol Oncol 1991; 41(3): 239–244. doi: 10.1016/0090-8258(91)90316-W.

Mourton SM, Temple LK, Abu-Rustum NR, Gemignani ML, Sonoda Y, Bochner BH, Barakat RR, Chi DS. Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer. Gynecol Oncol 2005; 99(3): 608–614. doi: 10.1016/j.ygyno.2005.07.112.

Tixier H, Fraisse J, Chauffert B, Mayer F, Causeret S, Loustalot C, Deville C, Bonnetain F, Sagot P, Douvier S, Cuisenier J. Evaluation of pelvic posterior exenteration in the management of advanced-stage ovarian cancer. Arch Gynecol Obstet 2010; 281(3): 505–510. doi: 10.1007/s00404-009-1175-0.

Bidzinski M, Derlatka P, Kubik P, Ziolkowska-Seta I, Dańska-Bidzinska A, Gmyrek L, Sobiczewski P, Panek G. The evaluation of intra- and postoperative complications related to debulking surgery with bowel resection in patients with FIGO stage III–IV ovarian cancer. Int J Gynecol Cancer 2007; 17(5): 993–997. doi: 10.1111/j.1525-1438.2007.00896.x.

Song YJ, Lim MC, Kang S, Seo SS, Park JW, Choi HS, Park SY.Total colectomy as part of primary cytoreductive surgery in advanced Müllerian cancer. Gynecol Oncol 2009; 114(2): 183–187. doi: 10.1016/j.ygyno.2009.04.009.

Kommoss S, Rochon J, Harter P, Heitz F, Grabowksi JP, Ewald-Riegler N, Haberstroh M, Neunhoeffer T, Barinoff J, Gomez R, Traut A, du Bois A. Prognostic impact of additional extended surgical procedures in advanced-stage primary ovarian cancer. Ann Surg Oncol 2010; 17(1): 279–286. doi: 10.1245/s10434-009-0787-8.

Salani R, Zahurak ML, Santillan A, Giuntolli RL 2nd, Bristow RE. Survival impact of multiple bowel re-sections in patients undergoing primary cytoreductive surgery for advanced ovarian cancer: A case-control study. Gynecol Oncol 2007; 107(3): 495–499. doi: 10.1016/j.ygyno.2007.08.003.

Hunter RW, Alexander ND, Soutter WP. Meta-analysis of surgery in advanced ovarian carcinoma: Is maximum cytoreductive surgery an independent determinant of prognosis? Am J Obstet Gynecol 1992; 166(2): 504–511. doi: 10.1016/0002-9378(92)91658-W.

Potter ME, Partridge EE, Hatch KD, Soong SJ, Austin JM, Shingleton HM. Primary surgical therapy of ovarian cancer: How much and when. Gynecol Oncol 1991; 40(3): 195–200. doi: 10.1016/0090-8258(90)90277-R.

Crawford SC, Vasey PA, Paul J, Hay A, Davis JA, Kaye SB. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 trial. J Clin Oncol 2005; 23(34): 8802–8811. doi: 10.1200/JCO.2005.02.1287.

Todo Y, Sakuragi N, Oikawa M, Negishi H, Yamamoto R, Yoshiaki K, Tsumura N, Kawaguchi I, Fujimoto S. Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma. Int J Clin Oncol 2003; 8(2): 90–96. doi: 10.1007/s101470300016.

Aletti GD, Gostout BS, Podratz KC, Cliby WA. Ovarian cancer surgical resectability: Relative impact of disease, patient status, and surgeon. Gynecol Oncol 2006; 100(1): 33–37. doi: 10.1016/j.ygyno.2005.07.123.

Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975; 42: 101–104.

Chéreau E, Ballester M, Selle F, Cortez A, Daraï E, Rouzier R. Comparison of peritoneal carcinomatosis scoring methods in predicting resectability and prognosis in advanced ovarian cancer. Am J Obstet Gynecol 2010; 202(2): 178. doi: 10.1016/j.ajog.2009.10.856.

Chang SJ, Bristow RE. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: Redefining ‘optimal’ residual disease. Gynecol Oncol 2012; 125(2): 483–492. doi: 10.1016/j.ygyno.2012.02.024.

Aletti GD, Podratz KC, Jones MB, Cliby WA. Role of rectosigmoidectomy and stripping of the peritoneum in outcomes of patients with advanced-ovarian cancer. J Am Coll Surg 2006; 203(4): 521–526. doi: 10.1016/j.jamcollsurg.2006.06.027.

Park JY, Seo SS, Kang S, Lee KB, Lim SY, Choi HS, Park SY. The benefits of low anterior en bloc resection as part of cytoreductive surgery for advanced primary and recurrent epithelial ovarian cancer patients outweigh morbidity concerns. Gynecol Oncol 2006; 103(3): 977–984. doi: 10.1016/j.ygyno.2006.06.004.

Houvenaeghel G, Gutowski M, Buttarelli M, Cuisenier J, Narducci F, Dalle C, Ferron G, Morice P, Meeus P, Stockle E, Bannier M, Lambaudie E, Rouanet P, Fraisse J, Leblanc E, Dauplat J, Querleu D, Martel P, Castaigne D. Modified posterior pelvic exenteration for ovarian cancer. Int J Gynecol Cancer 2009; 19(5): 968–973. doi: 10.1111/IGC.0b013e3181a7f38b.

Bristow RE, Peiretti M, Zanagnolo V, Salani R, Giuntoli II RL, Maggioni A. Transverse colectomy in ovarian cancer surgical cytoreduction: Operative technique and clinical outcome. Gynecol Oncol 2008; 109: 364–369. doi: 10.1016/j.ygyno.2008.02.020.

Silver DF, Zgheib NB. Extended left colon resections as part of complete cytoreduction for ovarian cancer: Tips and considerations. Gynecol Oncol 2009; 114: 427–30. doi: 10.1016/j.ygyno.2009.05.037.

Hoffman MS, Tebes SJ, Sayer RA, Lockhart J. Extended cytoreduction of intraabdominal metastatic ovarian cancer in the left upper quadrant utilizing en bloc resection. Am J Obstet Gynecol 2007; 197(2): e1–e4. doi: 10.1016/j.ajog.2007.04.049.

Kehoe SM, Eisenhauer EL, Abu-Rustum NR, Sonoda Y, D’Angelica M, Jarnagin WR, Barakat RR, Chi DS. Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer. Gynecol Oncol 2009; 112(3): 496–450. doi: 10.1016/j.ygyno.2008.10.011.

Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO, Podratz KC, Cliby WA. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 2006; 107(1): 77–85. doi: 10.1097/



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