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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(09): 866-875
DOI: 10.1055/a-2331-0900
GebFra Science
Original Article

The Impact of Upper Abdominal Surgery Regarding the Outcome of Patients with Advanced Ovarian Cancer

Auswirkung der Oberbauchchirurgie auf die Prognose von Patientinnen mit fortgeschrittenem Ovarialkarzinom
Maximilian Pietschmann  ‡
1   Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Anna Jaeger‡
1   Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Susanne Reuter
1   Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
,
Barbara Schmalfeldt
1   Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)
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Abstract

Objective

Residual tumor after cytoreductive surgery is the most important prognostic parameter for the outcome of patients with advanced ovarian cancer (5-year survival rate FIGO III 39%, FIGO IV 20%). As more than half of the patients suffer from upper abdominal tumor burden, surgery in this area is inevitable in order to achieve adequate cytoreduction. Our analysis focuses on the impact of upper abdominal interventions (UAI) regarding residual tumor and prognosis (OS, PFS).

Methods

A total of n = 261 patients with advanced primary ovarian cancer stage FIGO III and IV and radical cytoreductive surgery at the Gynecologic Cancer Center Hamburg-Eppendorf between 2014 and 2019 were analyzed in a retrospective study design and divided into two groups: one with UAI (n = 160) and one without UAI (n = 101).

Results

Patients with UAI showed significantly more often a residual tumor of less than 1 cm (R1) than patients without UAI and had a significantly longer OS (59 vs. 45 months [p = 0.041]). Deperitonealization of the diaphragm was the most common (144/160) and prognostically most relevant procedure for UAI. Especially the subgroup with FIGO IIIC stage seemed to benefit most from UAI. However, in multivariate analysis residual tumor burden was the strongest prognostic parameter for survival, followed by FIGO stage and UAI. Mortality was low within in the UAI group (0.6%).

Conclusion

UAI is an essential part of cytoreductive surgery in advanced ovarian cancer patients with tumor spread into the upper abdomen as it significantly prolongs survival. The procedure appears to be safe with low mortality. Achieving R1 rather than R2 due to radical surgery combined with UAI should be preferred compared to the early termination of the operation, as this has a significant impact on the prognosis of the patients.

Zusammenfassung

Zielsetzung

Der Resektionsstatus nach zytoreduktiver Chirurgie ist der wichtigste prognostische Parameter für die Prognose von Patientinnen mit fortgeschrittenem Ovarialkarzinom (5-Jahres-Überlebensrate: FIGO III 39%, FIGO IV 20%). Da mehr als die Hälfte der Patientinnen an einem Tumorbefall im Oberbauch leiden, ist ein chirurgischer Eingriff in diesem Bereich unausweichlich, um eine adäquate Zytoreduktion zu erzielen. Unsere Analyse untersucht den Einfluss von chirurgischen Eingriffen am Oberbauch (OB) auf den Resektionsstatus und die Prognose.

Methoden

Es handelt sich um eine retrospektive Studie von Patientinnen mit fortgeschrittenem primären Ovarialkarzinom im FIGO-Stadium III und IV. Insgesamt wurden n = 261 Patientinnen zwischen 2014 und 2019 im Universitätsklinikum Hamburg-Eppendorf einer radikalen zytoreduktiven Chirurgie unterzogen. Für die retrospektive Analyse wurden die Patientinnen in 2 Gruppen unterteilt: Die erste Gruppe erhielt einen OB-EIngriff (n = 160), und die zweite Gruppe wurde ohne OB-Eingriff operiert (n = 101).

Ergebnisse

Patientinnen mit OB-Eingriff hatten signifikant häufiger einen Tumorrest unter 1 cm (R1) als Patientinnen, die keine OB-Intervention erhalten hatten. Das Gesamtüberleben von Patientinnen nach einem OB-Eingriff war zudem signifikant länger (59 vs. 45 Monate [p = 0,041]). Die Deperitonealisierung des Diaphragmas war der häufigste (144/160) und prognostisch relevanteste OB-Eingriff. Die Untergruppe mit FIGO-Stadium IIIC schien am meisten von der OB-Chirurgie zu profitieren. Eine multivariate Analyse zeigte aber, dass die verbleibende Tumorlast der wichtigste prognostischer Parameter für das Gesamtüberleben war, gefolgt von FIGO-Stadium und einem OB-Eingriff. Die Mortalität in der OB-Interventionsgruppe war niedrig (0,6%).

Schlussfolgerung

Die Durchführung eines Eingriffs am Oberbauch ist ein wesentlicher Bestandteil der zytoreduktiven Chirurgie bei Patientinnen mit fortgeschrittenem Ovarialkarzinom und Tumorausbreitung im Oberbauch und verlängert das Überleben signifikant. Der OB-Eingriff gilt als sicher und hat eine niedrige Mortalität. Das Ziel sollte eher eine R1- als eine R2-Resektion sein. Damit ist bei Tumorbefall die Oberbauchchirurgie im Rahmen des Tumordebulking im Gegensatz zu einer frühzeitigen Beendigung des chirurgischen Eingriffs zu bevorzugen, da der zu erreichende R1-Status einen signifikanten Einfluss auf die Prognose der Patientinnen hat.

Keywords

cancer registry - ovarian cancer - ovary

Schlüsselwörter

Krebsregister - Ovarmalignom - Ovar


Publication History

Received: 23 February 2024

Accepted after revision: 17 May 2024

Article published online:
04 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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