Intrathoracic Disease and Advanced Ovarian Cancer: Focus on Video-Assisted Surgery
Posted: Monday, October 12, 2020
According to a single-center retrospective study, video-assisted thoracic surgery may be effective in determining the extent of intrathoracic disease in patients with advanced ovarian carcinoma who have moderate or large pleural effusions. Dennis S. Chi, MD, FACOG, FACS, of Memorial Sloan Kettering Cancer Center, New York, and colleagues published their study results in Gynecologic Oncology. They suggest this surgical approach may be useful in making therapeutic decisions for this patient population.
“These findings have led us to change our prior management algorithm,” the authors wrote. “In the modified algorithm, patients who do not have macroscopic intrathoracic disease can be offered primary debulking surgery. Patients who have intrathoracic macroscopic disease that cannot be resected or ablated should be offered neoadjuvant chemotherapy/interval debulking surgery.”
Between 2001 and 2019, 100 patients underwent video-assisted thoracic surgery to assess for macroscopic intrathoracic disease. The patients’ median age was 60 years. The authors’ previously determined management algorithm recommended primary debulking surgery for women with tumors 1 cm and smaller and neoadjuvant chemotherapy/interval debulking surgery for women with tumors larger than 1 cm.
The researchers found macroscopic pleural disease in 70 patients and attempted primary debulking surgery on 50 of them. Neoadjuvant chemotherapy was given to the remaining 50 patients, 47 of whom also had interval debulking surgery. Patients who underwent primary debulking surgery had significantly longer survival than those who had neoadjuvant chemotherapy/interval debulking surgery (45.8 months vs. 37.4 months).
The median overall survival was 44.5 months. Two variables were independently associated with lower survival: macroscopic intrathoracic disease (hazard ratio = 2.18) and age of 65 years or older (hazard ratio = 1.98). The group with the best outcome—a median overall survival of 87.8 months—had no macroscopic disease detected during video-assisted surgery and underwent primary debulking surgery.
Disclosure: The study authors’ disclosure information may be found at sciencedirect.com.