Depth of colorectal-wall invasion and lymph-node involvement as major outcome factors influencing surgical strategy in patients with advanced and recurrent ovarian cancer with diffuse peritoneal metastases

World Journal of Surgical Oncology

Paolo Sammartino¹  Marialuisa Framarino³  Tommaso Cornali¹  Antonio Ciardi²  Fabio Accarpio¹  Simone Sibio¹  Daniele Biacchi¹  Maurizio Cardi¹  Angelo Di Giorgio¹ 

[1] Department of Surgery ‘Pietro Valdoni’, Sapienza University of Rome Azienda Policlinico Umberto I, viale del Policlinico, 155, Rome, 00161Italy;Department of Experimental Medicine, Sapienza University of Rome - Azienda Policlinico Umberto I, viale del Policlinico, 155, Rome, 00161, Italy;Department of Obstetrics and Gynecology, Sapienza University of Rome Azienda Policlinico Umberto I, viale del Policlinico, 155, Rome, 00161, Italy

关键词: Mesenteric lymph node involvement;    Depth of bowel wall invasion;    Colorectal resection;    Peritoneal metastases;    Ovarian cancer;   

Others  :  825916
DOI  :  10.1186/1477-7819-11-64

 received in 2012-10-03, accepted in 2013-02-16,  发布年份 2013

【 摘 要 】

Background

More information is needed on the anatomopathological outcome variables indicating the appropriate surgical strategy for the colorectal resections often needed during cytoreduction for ovarian cancer.

Methods

From a phase-II study cohort including 70 patients with primary advanced or recurrent ovarian cancer with diffuse peritoneal metastases treated from November 2000 to April 2009, we selected for this study the 52 consecutive patients who needed colorectal resection. Data collected included type of colorectal resection, peritoneal cancer index (PCI), histopathology (depth of bowel-wall invasion and lymph-node spread), cytoreduction rate and outcome. Correlations were tested between possible prognostic factors and Kaplan-Meier five-year overall and disease-free survival. A Cox multivariate regression model was used to identify independent variables associated with outcome.

Results

In the 52 patients, the optimal cytoreduction rate was 86.5% (CC0/1). In all patients, implants infiltrated deeply into the bowel wall, in 75% of the cases up to the muscular and mucosal layer. Lymph-node metastases were detected in 50% of the cases; mesenteric nodes were involved in 42.3%. Most patients (52%) had an uneventful postoperative course. Operative mortality was 3.8%. The five-year survival rate was 49.9% and five-year disease-free survival was 36.7%. Cox regression analysis identified as the main prognostic factors completeness of cytoreduction and depth of bowel wall invasion.

Conclusions

Our findings suggest that the major independent prognostic factors in patients with advanced ovarian cancer needing colorectal resections are completeness of cytoreduction and depth of bowel wall invasion. Surgical management and pathological assessment should be aware of and deal with dual locoregional and mesenteric lymphatic spread.

【 授权许可】

   
2013 Di Giorgio et al; licensee BioMed Central Ltd.

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