Peritonectomy Improves Ovarian Cancer Surgery Outcomes

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a.crandon

Safety / feasability study of peritonectomy for advanced ovarian/peritoneal cancer

Negócios Saúde e medicina

Peritonectomy Is this a realistic, safe and viable option for improving ovarian cancer cytoreductive surgery? Alex J Crandon & Marcelo Carraro Nascimento Qld Centre for Gyn. Cancer

Advantages of Cytoreductive Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Residual Disease –v- Survival in Advanced EOC 16 (>2cm) 45 (<2cm) Delgado, G 1984 16 (>2cm) 45 (<2cm) Pohl, R 1984 14 (>2cm) 25+ (<2cm) Conte, P 1985 8 ( >1cm) 19 ( ≤1cm) Zang, RY 2000 18 (>2cm) 30+ (<2cm) Posada, JG 1985 15 ( ≥2cm) 24 (<2cm) Louie, KG 1986 21 (>3cm) 72 ( ≤3cm) Hainsworth, J 1988 21 (>1cm) 48 ( ≤1cm) Piver, MS 1988 23 ( ≥3cm) 45 (<3cm) Sutton, GP 1989 15 (>2cm) 25 ( ≤2cm) Munkarah 1997 10 ( >1cm) 38 ( ≤1cm) Bristow, RE 1999 Suboptimal debulking Survival (months) Optimal debulking Survival (months) Study

Optimal Debulking ,[object Object],[object Object],[object Object]

QCGC Database ,[object Object],[object Object],[object Object]

Stage 3C EOC Breakdown 100 701 Total 24.1 169 Unknown 9.3 65 Gross 6.4 45 >2cm 8.6 60 1-2cm 32.4 227 <1cm 19.3 135 Nil Percent Number Residual Disease

Stage IIIC EOC Residual Disease –v- Disease Specific Survival

Stage IIIC EOC Residual Disease and Relapse Free Survival

Conclusions ,[object Object],[object Object],[object Object]

Management of Advanced Disease ,[object Object],[object Object],[object Object]

Peritonectomy Study ,[object Object],[object Object]

Peritonectomy Methodology ,[object Object],[object Object],[object Object],[object Object]

Peritonectomy Workup ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

One Patient Rejected ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Peritonectomy Admission ,[object Object],[object Object],[object Object],[object Object],[object Object]

Day of Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Peritonectomy Methodology ,[object Object],[object Object],[object Object],[object Object],[object Object]

Important Aspects ,[object Object],[object Object],[object Object]

Peritonectomy Patients Died of bowel obstruction FOD ?PD ?PD FOD FOD FOD DOD SD FOD Recurrence (L & H) FOD Status 2 7.5 3C R Ovary 77 PP 3 14 3C Peritoneum 53 SW 7 10.25 3C R Ovary 66 ES 4 17 D R Appendix 61 VM 8 13 3C R Ovary 57 SM 0 10.25 4 R Mesothelioma 40 KC 3 10 3C Ovary 60 SD 3 5.75 4 R Mesothelioma 59 ML 0 5 3C R Peritoneum 59 IK 3 8.5 3C Peritoneum 74 MT 0 5 3C Ovary 65 VW 0 5.5 3C R Ovary 54 SB Intra-op Transfusion (units) Operative Time (hrs) Stage Primary Disease Site Age Patient

Peritonectomy Extent of Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Post Operative Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

Total Peritonectomy Post-operative Complications ,[object Object],[object Object],[object Object],[object Object]

Modified/Subtotal Peritonectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lessons Learnt ,[object Object],[object Object],[object Object],[object Object],[object Object]

Where could we be? 100 20.2 8.8 8.8 60.3 Modified Peritonectomy 100 886 Total 20.2 179 Unknown 8.8 78 Gross 8.8 78 >2cm 10.3 92 1-2cm 34.1 302 <1cm 17.8 158 Nil Percent Number Residual Disease

Conclusion 1 from Peritonectomies ,[object Object]

Conclusion 2 from Peritonectomies ,[object Object]

Conclusion 3 from Peritonectomies ,[object Object],[object Object]

Conclusion 4 from Peritonectomies ,[object Object]

Conclusion 5 from Peritonectomies ,[object Object]

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Peritonectomy Improves Ovarian Cancer Surgery Outcomes

1. Peritonectomy Is this a realistic, safe and viable option for improving ovarian cancer cytoreductive surgery? Alex J Crandon & Marcelo Carraro Nascimento Qld Centre for Gyn. Cancer

3. Residual Disease –v- Survival in Advanced EOC 16 (>2cm) 45 (<2cm) Delgado, G 1984 16 (>2cm) 45 (<2cm) Pohl, R 1984 14 (>2cm) 25+ (<2cm) Conte, P 1985 8 ( >1cm) 19 ( ≤1cm) Zang, RY 2000 18 (>2cm) 30+ (<2cm) Posada, JG 1985 15 ( ≥2cm) 24 (<2cm) Louie, KG 1986 21 (>3cm) 72 ( ≤3cm) Hainsworth, J 1988 21 (>1cm) 48 ( ≤1cm) Piver, MS 1988 23 ( ≥3cm) 45 (<3cm) Sutton, GP 1989 15 (>2cm) 25 ( ≤2cm) Munkarah 1997 10 ( >1cm) 38 ( ≤1cm) Bristow, RE 1999 Suboptimal debulking Survival (months) Optimal debulking Survival (months) Study

6. Stage 3C EOC Breakdown 100 701 Total 24.1 169 Unknown 9.3 65 Gross 6.4 45 >2cm 8.6 60 1-2cm 32.4 227 <1cm 19.3 135 Nil Percent Number Residual Disease

7. Stage IIIC EOC Residual Disease –v- Disease Specific Survival

8. Stage IIIC EOC Residual Disease and Relapse Free Survival

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20. Peritonectomy Patients Died of bowel obstruction FOD ?PD ?PD FOD FOD FOD DOD SD FOD Recurrence (L & H) FOD Status 2 7.5 3C R Ovary 77 PP 3 14 3C Peritoneum 53 SW 7 10.25 3C R Ovary 66 ES 4 17 D R Appendix 61 VM 8 13 3C R Ovary 57 SM 0 10.25 4 R Mesothelioma 40 KC 3 10 3C Ovary 60 SD 3 5.75 4 R Mesothelioma 59 ML 0 5 3C R Peritoneum 59 IK 3 8.5 3C Peritoneum 74 MT 0 5 3C Ovary 65 VW 0 5.5 3C R Ovary 54 SB Intra-op Transfusion (units) Operative Time (hrs) Stage Primary Disease Site Age Patient

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26. Where could we be? 100 20.2 8.8 8.8 60.3 Modified Peritonectomy 100 886 Total 20.2 179 Unknown 8.8 78 Gross 8.8 78 >2cm 10.3 92 1-2cm 34.1 302 <1cm 17.8 158 Nil Percent Number Residual Disease

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Peritonectomy Improves Ovarian Cancer Surgery Outcomes

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