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  • br Among patients with cm of re sidual

    2019-10-21


    Among patients with 1 cm of re-sidual disease confined to a single anatomic site (n¼34), the most com-mon locations of residual disease tu-mor nodule(s) were the SC 560 (41.2%), bowel mesentery (20.6%), and the pelvis (17.6%). Other loca-tions for residual disease included bowel serosa (11.8%), pelvic or para-aortic lymph node (2.9%), and abdominal peritoneum (5.9%). Among patients who had 1 cm of residual disease that involved multiple 
    TABLE 1
    Patient demographics and clinical characteristics
    Number of % or median, Characteristic patients range
    Race
    Charlson Comorbidity Index
    Number of chemotherapy cycles preoperatively, 3.0 2e13 median, range
    Number of chemotherapy cycles postoperatively, 3.0 0e10 median, range
    Stage
    Tumor grade
    Primary site
    Histology
    Endometrioid 2 0.7%
    Carcinosarcoma 5 1.9%
    Manning-Geist et al. A novel classification of residual disease after interval debulking surgery for advanced-stage ovarian cancer to better distinguish oncologic outcome. Am J Obstet Gynecol 2019.
    MONTH 2019 American Journal of Obstetrics & Gynecology 1.e3
    Original Research GYNECOLOGY ajog.org
    TABLE 2
    Operative characteristics and perioperative morbidity
    Characteristic Number of patients % or median, range
    Required intraoperative blood transfusion 47 17.4%
    Surgical complexity group
    Residual disease
    Complete surgical resection 173 64.1%
    Hospital length of stay, d, median, range 6 1e27
    Readmission within 30 days of surgery 26 9.6%
    Reoperation within 30 days of surgery 13 4.8%
    Postoperative ICU admission 13 4.8%
    Required postoperative blood transfusion 118 43.7%
    Postoperative complication
    Bowel perforation or anastomotic leak 0.0%
    Small bowel obstruction 3 1.1%
    Myocardial infarction 0.0%
    Intra-abdominal infection 13 3.3%
    Urinary tract infection 13 4.8%
    Unable to resume chemotherapy 1 0.4%
    DVT, deep-vein thrombosis; EBL, estimated blood loss; PE, pulmonary embolism; ICU, intensive care unit.
    Manning-Geist et al. A novel classification of residual disease after interval debulking surgery for advanced-stage ovarian cancer to better distinguish oncologic outcome. Am J Obstet Gynecol 2019. 
    2.84; 95% CI, 1.45e5.56). On uni-variate analysis, volume of residual disease was the only factor associated with an increased risk of death. Other variables, including age, race, adjusted Charlson Comorbidity Index, primary site, stage, grade, histology, and sur-gical complexity score did not signif-icantly influence OS.
    cm-ML, and 6 months (range: 0e28 months) for SO-debulked (P<.001). KaplaneMeier curves for PFS by vol-ume of residual disease are displayed in Figure 1. On univariate analysis, stage IV disease (compared with stage IIIC) was found to increase the risk of recurrence (HR, 1.27; 95% CI, 0.98e1.64), but Polymorphism did not meet statistical significance. Compared with  Discussion Principal findings
    Although both the 1 cm-SL and 1 cm-ML groups presented in this study would traditionally be described as “optimally debulked,” this study shows that patients with 1 cm-ML have a similar oncologic outcome to SO-debulked patients. Therefore, surgical aggressiveness to achieve CSR is of the utmost importance and, when this is not achievable, 1 cm-SL also may afford a
    1.e4 American Journal of Obstetrics & Gynecology MONTH 2019
    ajog.org GYNECOLOGY Original Research
    FIGURE 1
    Influence of residual disease volume on PFS
    1 cm-ML, 1 cm greatest diameter of residual disease involving multiple anatomic locations; 1 cm-SL, 1 cm greatest diameter of residual disease confined to a single anatomic location; CSR, complete surgical resection; PFS, progression-free survival.