{
    "abstract": "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).\nA total of n\u00a0=\u00a0261 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\u00a0=\u00a0160) and one without UAI (n\u00a0=\u00a0101).\nPatients with UAI showed significantly more often a residual tumor of less than 1\u00a0cm (R1) than patients without UAI and had a significantly longer OS (59 vs. 45 months [p\u00a0=\u00a00.041]). 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%).\nUAI 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.\nDer Resektionsstatus nach zytoreduktiver Chirurgie ist der wichtigste prognostische Parameter f\u00fcr die Prognose von Patientinnen mit fortgeschrittenem Ovarialkarzinom (5-Jahres-\u00dcberlebensrate: FIGO III 39%, FIGO IV 20%). Da mehr als die H\u00e4lfte der Patientinnen an einem Tumorbefall im Oberbauch leiden, ist ein chirurgischer Eingriff in diesem Bereich unausweichlich, um eine ad\u00e4quate Zytoreduktion zu erzielen. Unsere Analyse untersucht den Einfluss von chirurgischen Eingriffen am Oberbauch (OB) auf den Resektionsstatus und die Prognose.\nEs handelt sich um eine retrospektive Studie von Patientinnen mit fortgeschrittenem prim\u00e4ren Ovarialkarzinom im FIGO-Stadium III und IV. Insgesamt wurden n\u00a0=\u00a0261 Patientinnen zwischen 2014 und 2019 im Universit\u00e4tsklinikum Hamburg-Eppendorf einer radikalen zytoreduktiven Chirurgie unterzogen. F\u00fcr die retrospektive Analyse wurden die Patientinnen in 2 Gruppen unterteilt: Die erste Gruppe erhielt einen OB-EIngriff (n\u00a0=\u00a0160), und die zweite Gruppe wurde ohne OB-Eingriff operiert (n\u00a0=\u00a0101).\nPatientinnen mit OB-Eingriff hatten signifikant h\u00e4ufiger einen Tumorrest unter 1\u00a0cm (R1) als Patientinnen, die keine OB-Intervention erhalten hatten. Das Gesamt\u00fcberleben von Patientinnen nach einem OB-Eingriff war zudem signifikant l\u00e4nger (59 vs. 45 Monate [p\u00a0=\u00a00,041]). Die Deperitonealisierung des Diaphragmas war der h\u00e4ufigste (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 f\u00fcr das Gesamt\u00fcberleben war, gefolgt von FIGO-Stadium und einem OB-Eingriff. Die Mortalit\u00e4t in der OB-Interventionsgruppe war niedrig (0,6%).\nDie Durchf\u00fchrung eines Eingriffs am Oberbauch ist ein wesentlicher Bestandteil der zytoreduktiven Chirurgie bei Patientinnen mit fortgeschrittenem Ovarialkarzinom und Tumorausbreitung im Oberbauch und verl\u00e4ngert das \u00dcberleben signifikant. Der OB-Eingriff gilt als sicher und hat eine niedrige Mortalit\u00e4t. 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 fr\u00fchzeitigen Beendigung des chirurgischen Eingriffs zu bevorzugen, da der zu erreichende R1-Status einen signifikanten Einfluss auf die Prognose der Patientinnen hat.",
    "authors": [
        {
            "affiliation": "Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.",
            "firstname": "Maximilian",
            "initials": "M",
            "lastname": "Pietschmann"
        },
        {
            "affiliation": "Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.",
            "firstname": "Anna",
            "initials": "A",
            "lastname": "Jaeger"
        },
        {
            "affiliation": "Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.",
            "firstname": "Susanne",
            "initials": "S",
            "lastname": "Reuter"
        },
        {
            "affiliation": "Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.",
            "firstname": "Barbara",
            "initials": "B",
            "lastname": "Schmalfeldt"
        }
    ],
    "conclusions": "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.",
    "copyrights": "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/).\nThe 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/).",
    "doi": "10.1055/a-2331-0900\n10.3322/caac.20107\n10.1111/j.1471-0528.2005.00572.x\n10.3238/arztebl.2011.0635\n10.1016/j.ygyno.2013.05.040\n10.1002/cncr.24149\n10.1056/NEJMoa1911361\n10.1200/JCO.2002.20.5.1248\n10.1016/s0090-8258(03)00278-6\n10.1006/gyno.2001.6312\n10.1016/j.ygyno.2007.10.001\n10.1016/j.ygyno.2004.04.032\n10.1016/j.ygyno.2005.08.027\n10.1016/j.ygyno.2005.08.036\n10.1016/j.ygyno.2008.02.020\n10.1016/j.ygyno.2008.10.011\n10.1016/j.ygyno.2006.06.028\n10.1055/a-2055-9349\n10.1016/j.ygyno.2015.03.043\n10.1016/j.ygyno.2009.11.023\n10.1016/j.ygyno.2009.03.011\n10.1002/ijgo.13878\n10.1016/S0140-6736(14)62223-6\n10.1056/NEJMoa1810858\n10.1136/ijgc-2020-001243\n10.1056/NEJMoa1808424\n10.1200/JCO.2014.56.3106\n10.1016/j.ygyno.2009.03.018\n10.1016/j.ygyno.2008.02.012\n10.1016/j.ygyno.2015.12.019\n10.1097/01.AOG.0000192407.04428.bb",
    "journal": "Geburtshilfe und Frauenheilkunde",
    "keywords": [
        "cancer registry",
        "ovarian cancer",
        "ovary"
    ],
    "methods": null,
    "publication_date": "2024-09-04",
    "pubmed_id": "39229631\n21296855\n15957984\n22025930\n23747291\n19189349\n31851799\n11870167\n12893206\n11520145\n17996927\n15350355\n16182350\n16202446\n18396322\n26124365\n19091388\n16890277\n37588253\n25824857\n20004958\n19344936\n30306591\n26002111\n30345884\n32616627\n30811909\n25667285\n19395008\n18384866\n26757238\n16394043",
    "results": "Patients with UAI showed significantly more often a residual tumor of less than 1\u00a0cm (R1) than patients without UAI and had a significantly longer OS (59 vs. 45 months [p\u00a0=\u00a00.041]). 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%).",
    "title": "The Impact of Upper Abdominal Surgery Regarding the Outcome of Patients with Advanced Ovarian Cancer.",
    "xml": "<Element 'PubmedArticle' at 0x788505b070b0>"
}