Limited utility of conventional criteria for predicting unresectable disease in patients with advanced stage epithelial ovarian cancer

ObjectiveTo evaluate the predictive value of conventional criteria for identifying surgically unresectable disease among patients with ovarian cancer undergoing initial operative intervention at tertiary referral centers employing a so-called aggressive approach to surgical cytoreduction.MethodsAll patients with advanced epithelial ovarian cancer undergoing primary surgery between August 1997 and August 2006 were identified. Surgical/pathological documentation of disease extent pre/post-cytoreduction was extracted from the medical record retrospectively. All patients meeting conventional criteria for unresectable disease criteria (ascites> 1000 mL, omental extension to spleen > 1 cm, parenchymal liver disease > 1cm, porta hepatis involvement > 1 cm, diaphragmatic disease > 1 cm, carcinomatosis > 1 cm, and suprarenal adenopathy > 1 cm) were selected for further study.ResultsA total of 180 consecutive patients had disease meeting conventional criteria for unresectability at = 1 site(s). Optimal cytoreduction (residual disease = 1 cm) was achieved in 166 patients (92.2%). Optimal resection rates according to the most common individual unresectable disease criteria were as follows: ascites > 1000 mL = 91.3% (116/127), carcinomatosis > 1 cm = 91.0% (81/89), and splenic involvement > 1 cm = 84.9% (45/53). For patients with ascites > 1000 mL alone, optimal cytoreduction was achieved in 95.8% (46/48) of cases. Optimal resection rates according to the total number of unresectable disease sites were as follows: 1 site = 95.0% (19/20), 2 sites = 93.8% (61/65), 3 sites = 81.5% (22/27), 4 sites = 93.3% (14/15), and 5 sites = 80.0% (4/5).ConclusionsThese data suggest that commonly accepted criteria of surgically unresectable disease for women with advanced ovarian cancer lack the necessary precision to guide clinical management. Pre-operative assessment of resectability should be made by an experienced surgical team prior to deferring the initial attempt at surgical cytoreduction.