OvCa Surgery

Question 1

GOG-182 GynOnc 130 (2013) 487-492: analysis of prospective study 2001-2004: main conclusion?

Answer 1

High disease burden pts (disease on organs listed below) had minimal survival benefit from upper abdominal surgery (diaphragm stripping or resection 59%, liver resection 19%, splenectomy 18%, pancreatectomy 2%, porta-hepatis surgery 1%) unless they were cytoreduced to G0

UAP 18% of pts
32% CR rate

Question 2

LION RCT of LND after R0 CRS: complications rate: LND vs. none? (OS: 66 vs 69m despite 56% pts in LND group had + LN)

Answer 2

Time: 340 vs 280 min
Infections w/ antb: 26 vs 19%
Peripheral neuro events: 5% each
ReOp: 12 vs 7% (*due to leaks: 22 vs 8 events)
Death b chemo: 5 vs. 2%

Question 3

Rate of complete cytoreduction ~ radiologic status of cardiophrenic lymph nodes CPLN: ~ shortest axis of LN, per Du Bois study?

Answer 3

CPLN < 5mm - negative: 74%

5-9mm: 60%

10+ mm: 50%, p=0.004

Question 4

5y OS-PFS for pts with complete cytoreduction ~ radiologic status of cardiophrenic lymph nodes CPLN: > 5 mm shortest axis of LN considered +, per Du Bois study?

Answer 4

neg CPLN: 69% 5yOS - 41% 5yPFS

vs.

30 - 13% for +CPLN

Question 5

Pathologic confirmation of radiologically + cardiophrenic lymph nodes CPLN: > 5 mm and results of their resection in matched cohort study per Du Bois paper?

Answer 5

44/52 = 85%

No difference in PFS and OS

Question 6

What >5 mm cardiophrenic lymph nodes (CPLN) suggest about ovarian cancer distribution - du Bois?

cut off per European Society of Urogenital Radiology (ESUR) confirmed per analysis of study data

Answer 6

OR of 4 with:
> 2mm diaphragm thickness (79 vs. 48%)
Peritoneal carcinomatosis: (93 vs. 74%)

LN:
Groin - 1
Pelvic - 1.4
PALN- 2.48

Question 7

Anastomotic leak after colorectal anastomosis during OvCa debulking: Spain-UK-IT; N-457; BMI 25 - SD of 5; 6 hrs surgery; EBL-600; Risk factors associated with leak per multivariete analysis?

Answer 7

Age OR 1.05 per year: mean 58yo in no leak group
Albumin level: / by 1g/dL - 0.62 risk of leak: mean 3.8 in no leak group
Additional SB resection: OR 3.5 based on 55 vs. 7 cases
Manual anastomosis OR 8.3 based on 23 vs 4 cases

Question 8

Anastomotic leak after colorectal anastomosis during OvCa debulking: Spain-UK-IT; N-457; BMI 25 - SD of 5; 50% no additional bowel resection: Length of surgery?

Answer 8

No Leaks vs Leaks: 350 vs 395 minutes SD-140

2SD: 675 minutes= 11hrs 15min for longest 2.5% of surgeries

Question 9

Anastomotic leak after colorectal anastomosis during OvCa debulking: Spain-UK-IT; N-457; BMI 25 - SD of 5; 56% with LND, 30% splenectomy: EBL in no leaks vs leak group?

Answer 9

560 vs 640 cc in AL group

SD 440, thus <2.5% of patients in AL group had EBL of 1520cc

Question 10

EOC upstaging per 2021 meta of 5194 s.I-II pts (23 studies): overall rate and ~ histology?

Answer 10

19% overall upstaging rate

Among subtypes:
Serous - 35%
High grade tumor- 41%

Question 11

EOC positivity - upstaging rate per 2021 meta of 5194 s.I-II pts (23 studies): break down per surgical step?

Answer 11

Uterus: 6 - 6 %
Cytology: 18 - 9%
Peritoneum: 10 - 4%
Omentum: 5 - 4%
Appendix: 4 - 2%
LN p excluding mucinous EOC: 12 - 4% Plvc - 7% PA

Question 12

Pelvic mass surgery in Children: per ACOG’s “Adnexal mass” 2016?

Answer 12

7-25% in tertiary centers are malignant: mc germ cell tumors

Children’s Oncology Group:
-no spillage
-spare Fallopian tube if not adherent
-cytology
-exam/palpate/bx suspicious omentum & LN

Gyn > ovarian preservation than pediatric surgeon
Gyn Onc

Question 13

Benefit of CGR - R0 in serous vs. clear cell ovarian cancer?

Answer 13

clear cell&raquo_space; serous cancer

HR 0.39 vs. 0.58 minutes , p, CI

Question 14

CC Surgical oncology classification for completeness of cytoreduction

Answer 14

CC0
CC1 - nodules <2.5 mm

CC2 - nodules <2.5; 25 mm>
CC3 - nodules >25 mm or fusion

CC0 and CC1 are considered complete cytoreduction

Question 15

PCI scoring system:

Answer 15

1 - up to 0.5 cm
2 - up to 5 cm
3 - > 5 cm or fused

Max 39