Residual Disease after Cytoreductive Surgery

The volume of residual disease after cytoreductive surgery has been strongly associated with survival. Optimal cytoreduction is defined as residual disease of less than 1 cm. The GOG reported 37- and 31-month median survival times for patients with residual disease less than 1 cm and 1 to 2 cm, respectively. In an analysis of patients presenting with stage IV disease median survival of optimally cytoreduced patients was 38.4 months compared with 10.3 months for patients with suboptimal residual disease.54 In a prospective study of 465 patients with stage IIIC ovarian cancer, Chi and colleagues55 examined the significance of residual disease diameter on survival. Their analysis revealed that median overall survival in relation to the five residual disease categories was no gross residual—106 months; gross 0.5 cm or less—66 months; 0.6 to 1.0 cm—48 months; 1 to 2 cm—33 months; and more than 2 cm—34 months. Although the difference in survival did not reach statistical significance,

Figure 1-3. Ovarian cancer: tumor debulking. (From Hoskins WJ, McGuire WP, Brady MF, et al: 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 170(4):974-979, 1994; discussion 979-980.)

Figure 1-3. Ovarian cancer: tumor debulking. (From Hoskins WJ, McGuire WP, Brady MF, et al: 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 170(4):974-979, 1994; discussion 979-980.)

within the gross 1 cm or less residual group, there was a trend toward improved survival in patients with smaller-volume residual, that is, less than 0.5 cm compared with 0.6 to 1.0 cm (P = .06). In patients with suboptimal debulking, the difference in survival between those with less than 2 cm residual disease and those with more than 2 cm residual disease has been reported to be significant, although no difference in the risk of dying between groups was observed56 (Fig. 1-3). A meta-analysis of 6885 patients with stage III or IV ovarian cancer showed a statistically significant positive correlation between percent maximal cytoreduction and median survival time after controlling for all other variables (P < .001). Each 10% increase in maximal cytoreduction was associated with a 5.5% increase in median survival time. Cohorts with less than 25% maximal cytoreduction had a median survival time of 22.7 months compared with 33.9 months for cohorts with more than 75% cytoreduction57 (Table 1-6; see also Fig. 7-1).

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