Seda YÜKSEL ŞİMŞEK, Hüseyin AKILLI, İrem ALYAZICI KÜÇÜKYILDIZ, Ali AYHAN

Rekürren over kanseri hastalarında uygulanan tersiyer ve kuaterner sitoredüksiyon cerrahilerinin sağ kalıma etkisi ve morbiditesi

Amaç: Rekürren over kanseri hastalarında uygulanan tersiyer ve kuaterner sitoredüktif cerrahilerin sağ kalım ve morbidite sonuçlarının incelenmesidir. Gereç ve Yöntem: Hasta kayıtları retrospektif olarak incelenmiştir. Sağ kalım oranlarının tespitinde Kaplan-Meier sağ kalım analizi ve karşılaştırmalar için log-rank testleri kullanılmıştır. Tüm analizlerde anlamlı istatistiki değer p:

Analysis of survival and morbidity outcomes after tertiary and quaternary cytoreductive surgeries in recurrent ovarian cancer patients

Aim: To analyze the outcomes of tertiary and quaternary cytoreduction surgeries in recurrent ovarian cancer patients. Materials and Methods: Patients’ data were obtained retrospectively from hospital database. Kaplan-Meier method has been used to analyze survival outcomes. Results: A hundred and six patients diagnosed with recurrent ovarian cancer between dates February 2007-February 2012 were included into study. Tertiary and quaternary cytoreduction surgeries have been performed in 47 and 15 patients, respectively. Mean age at diagnosis was 54.1±11.2 years. Median follow up time was 40 months (min.: 4; max.: 130 months). Overall and median survival times were 66.5±5.1 and 56 months, respectively. Overall survival of patients operated for tertiary cytoreduction was significantly longer than survival of patients who had second recurrence but not operated and given chemotherapy only (73.8±7.3 vs 52.0±5.6 months) (p:0.039). Overall survival of platin-sensitive group was longer than platin-resistant group among tertiary cytoreduction group (78.8±8.2 vs 44.4±6.4), (p:0.121). Overall survival of patients operated for fourth time and given chemotherapy only were 63.7±7.5; 62.7±8.3 months respectively (p:0.616). Intraoperative complication rate is around 15% for both tertiary and quaternary cytoreduction. Postoperative complication rate is around 20-25%. The rate of intensive care unit requirement was highest after third and fourth cytoreductive surgeries compared to first and second cytoreduction and this difference was statistically significant (p:

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1. Bristow RE. Surgical standards in the management of ovarian cancer. Curr Opin Oncol Sep 2000; 12 (5): 474–80.
2. Chi DS, Franklin CC, Levine DA et al. Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube and primary peritoneal cancer: a change in surgical approach. Women’s Oncol Rev 2004; 4, (4): 263–4.
3. du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, and 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.Cancer 2009; 115 (6): 1234–44.
4. Kapp KS,Kapp DS, Poschauko J et al. The prognostic significance of peritoneal seeding and size of postsurgical residual in patients with stage III epithelial ovarian cancer treated with surgery, chemotherapy, and high-dose radiotherapy. Gynecol Oncol 1999; 74 (3): 400–7.
5. Harter P, Muallem ZM, Buhrmann C et al. Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. Gynecol Oncol 2011;121 (3): 615–9.
6. Muggia FM, Braly PS, Brady MF et al. Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol 2000; 18 (1): 106–15.
7. Zang RY, Zhang ZY, Li ZT et al. Impact of secondary cytoreductive surgery on survival of patients with advanced epithelial ovarian cancer. Eur J Surg Oncol 2000, 26 (8): 798–804.
8. Zang RY, Li ZT, Tang J et al. Secondary Cytoreductive Surgery for Patients with Relapsed Epithelial Ovarian Carcinoma: Who Benefits? Cancer 2004; 100 (6): 1152–61.
9. Ayhan A,Gultekin M, Taskiran C et al. The role of secondary cytoreduction in the treatment of ovarian cancer: Hacettepe University experience. Am J Obstet Gynecol 2006; 194 (1): 49–56.
10. Bristow RE, Puri I and Chi DS. Cytoreductive surgery for recurrent ovarian cancer: A meta-analysis. Gynecol Oncol 2009; 112 (1): 265–74.
11. Onda T, Yoshikawa H, Yasugi T, Yamada M, Matsumoto K, and Taketani Y. Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: Proposal for patients selection. Br J Cancer 2005; 92 (6): 1026–32.
12. Chi DS, McCaughty K, Diaz JP et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 2006; 106 (9): 1933–9.
13. Bickell NA, Egorova N, Prasad-Hayes M et al. Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer. Am J Clin Oncol Cancer Clin Trials 2018; 41 (5): 458–64.
14. Coleman RL, Spirtos NM, Enserro D et al. Secondary surgical cytoreduction for recurrent ovarian cancer. N Engl J Med 2019; 381 (20): 1929–39.
15. Fanfani F, Fagotti A, Ercoli A et al. Is There a Role for Tertiary (TCR) and Quaternary (QCR) Cytoreduction in Recurrent Ovarian Cancer? Anticancer Res 2015; 35 (12): 6951–5.
16. Leitao Jr MM, Kardos S, Barakat RR, and Chi DS. Tertiary cytoreduction in patients with recurrent ovarian carcinoma. Gynecol Oncol 2004; 95 (1): 181–8.
17. Arvas M, Salihoglu Y, Sal V et al. Tertiary cytoreduction for recurrent epithelial ovarian cancer: A multicenter study in Turkey. Asian Pacific J Cancer Prev 2016; 17 (4): 1909–15.
18. Shih KK, Chi DS, Barakat RR, and Leitao Jr MM. Beyond Tertiary Cytoreduction in Patients With Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer. Gynecol Oncol 2010, 116 (3): 364-9.
19. Fotopoulou C, Zang R, Gultekin M et al. Value of tertiary cytoreductive surgery in epithelial ovarian cancer: An international multicenter evaluation. Annals of Surgical Oncology 2013; 20 (4): 1348–54.
20. Fotopoulou C,Savvatis K,Kosian P et al. Quaternary cytoreductive surgery in ovarian cancer: Does surgical effort still matter. Br J Cancer 2013; 108 (1): 32–8.
21. Falcone F, Scambia C, Benedetti Panici P et al. Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study. Gynecol Oncol 2017; 147 (1): 66–72.
22. Hirakawa T, Minaguchi T, Itani Y et al. Current status of tertiary debulking surgery and prognosis after secondary debulking surgery for recurrent müllerian epithelial cancer in Japan: a retrospective analysis of 164 patients (KCOG-G1402). World Journal of Surgical Oncology 2017; 15 (132): 1-7
23. Bacalbasa N, Balescu I, Vilcu M, Dima S and Brezean I. Upper abdominal resection as part of tertiary cytoreduction for relapsed ovarian cancer. In Vivo 2020; 34 (1): 407-11
24. Dogan NU, Schneider A, Chiantera V, Dogan S, and Dursun P. Tertiary cytoreduction in the setting of recurrent ovarian cancer (Review). Oncol Lett 2013; 6 (3): 642–7.
25. Karam AK, Santillan A, Bristow RE et al. Tertiary cytoreductive surgery in recurrent ovarian cancer: Selection criteria and survival outcome. Gynecol Oncol 2007; 104 (2): 377–80.
26. Bacalbasa N, Balescu I, Dima S,Brasoveanu V,Popescu I. The role of quaternary cytoreduction in recurrent epithelial ovarian cancer: a single center experience. Anticancer Res 2015; 35 (6): 3519-23.