Relative Surgical Factors On Survival To Patients With Ovarian Cancer: A Multivariate Analysis

Objective: The purpose was to identify the relative surgical factors on prognosis to patients with ovarian carcinoma. Methodes:Dates was extracted from patients who were treated at The Affiliated tumor hospital of Guangxi Medical University from 22 October,1992 to 30 December 2009.Kaplan-Meier survival estimates and COX proportional hazards model adjusted for covariates were used for analyses.Result:Of 534 patients ,the 1-year,3-year,5-year,10-year overall survival were 65%,55%,46%,33%,18%,respectively.Medial survival was 42.5 monthes.On multivariate analysis,stage,grade,residual volume after cytoreductive surgery,omentum removed,neoadjuvant chemotherapy were independent prognostic factors.On univariate analysis, the prognosis of patients with early stage are better than the prognosis of patients with advanced stage, the prognosis of patients with G1 are better than G2 and G3, the prognosis of patients with optimal cytoreductive surgery are better than those with no optimal cytoreductive surgery, the prognosis of patients with stageⅢtreated by lymphadenectomy are better than no lymphadenectomy,the prognosis of patients with optimal cytoreductive surgery treated by lymphadenectomy are better than no lymphadenectomy, the prognosis of patients treated by omentum removed are better than no omentum romoved regardless optimal cytoreductive surgery or no, the prognosis of patients with optimal cytoreductive surgery treated by bowel removed are better than no bowel romoved, the prognosis of patients with stgaeⅡtreated by appendectomy have a margin statistical significance than no appendectomy, the prognosis of patients without diaphragm metastases treated by optimal cytoreductive surgery are better than those with diaphragm metastases,NACT can not improve the prognosis..Conclusion: Stage,grade,residual volume after cytoreductive surgery,omentum removed,neoadjuvant chemotherapy are importment prognostic factors. OBJECTIVE:The role of systematic lymphadenectomy(SL) remains unclear for improving overall survival(OS) in epithelial ovarian cancer(EOC).To evaluation the role of SL for OS in EOC,we performed a meta-analysis for comparing the efficacy of OS between SL and unsystematic lymphadenectomy (USL)。METHODS: After the extensive literature search between January 1, 1995 and December 31,2010,we analyzed 17 studies (2 randomized controlled trials[RCTs] and 15 observational studies including 3 SEERs) with 74,754 patients with EOC who underwent staging laparotomy including SL or USL. RESULTS: SL was a favorable factor for OS compared with USL in all-stage (odds ratio[OR],O.55;95% confidence interval[CI],0.49-0.69, P=0.00001) EOC .Moreover LS inceased OS in early-stage(OR,0.52;95% CI,0.35-0.78,P=0.001) and advanced-stage(OR,0.52;95%CI,0.41-0.67,P<0.00001) EOC.SL improved OS in all-stage disease who underwent optimal dubulking surgery compared with USL(OR,0.65;95% CI,0.50-0.84,P=0.0009),whereas it could not improve OS statistically in early-stage and advanced-stage diseases. However,SL showed increased OS with marginal significance in advanced-stage EOC patients who treated with optimal debulking surgery(OR=0.60;95% CI,0.35-1.02,P=0.06).But we should cautionally consider results owing to the lack of RCTs and the deviation of weight by large-scale observational studies. CONCLUSION :These findings suggest that SL maybe can improve OS in EOC.However,because of the lack of RCTs,the efficacy of SL on OS is still undetermined,more relevant studies for investigating the role of SL in EOC are required. OBJECTIVE:The aim of this study was to evaluate the operative safety and clinical value of diaphragmatic surgery to patients with advanced and recurrent ovarian carcinoma. METHODS: After the extensive literature searched between January 1,2000 and December 31,2010,we reviewed all literatures about the patients with ovarian carcinoma who underwent diaphragmatic surgery. RESULTS: 12 literatures(retrospective) were met the inclusion criteria . The most operative complications were pleural effusion,then pneumothorax,pneumonia,subdiaphragmatic abscess et al . Only one patient died because of surgery . Operating room time ranged from 78 to 710 min . The length of hospitalization ranged from 4 to 40 days . whether primary or recurrent ovarian cancer, majority patients could achieved optimal cytoreductive surgery (residual tumor less than 2cm) . The proportion of optimal cytoreductive surgery and survival of patients with diaphragmatic surgery were higher than patients without diaphragmatic surgery. CONCLUSION: Diaphragmatic surgery was safty, it could increase the rates of optimal cytoreductive surgery and improve survival of patients with advanced or recurrent ovarian carcinoma. But more clinical trials were needed to demonstrate the conclusion . OBJECTIVE:The aim of this study was to assess the safety and efficacy associated with bowel resection with the cytoreduction procedure for ovarian carcinoma . METHODS: After the extensive literature searched between January 1, 2000 and December 31, 2010,we reviewed all literatures about the patients with ovarian cancer who underwent bowel resection . RESULTS: 27 literature(retrospective) were analysed .The most post-operative complications were infection(mean 20.7%).The major complications directly related to bowel resection were intestinal obstruction(mean 10.6%),and then intestinal fistula and stomal leak (mean 2.7%).Estimated blood loss ranged from 100 to 8500 ml.The length of hospitalization ranged from 4 to 79 days .The time of passage of gas by anus was about one week . Most authors considered that bowel resection could increase the rates of optimal cytoreductive surgery and improve survival of patients with ovarian carcinoma .In bowel resection group,the prognosis of patients with optimal cytoreduction surgery were better than patients with suboptimal cytoreduction surgery .The depth of lesion invasion may be affect the disease-free survival of patients ,but not affect the overall survival .CONCLUSION:Bowel resection was safty, it could increase the rates of optimal cytoreductive surgery and improve survival of patients with ovarian carcinoma who achieved optimal cytoreduction . But more clinical trials were needed to demonstrate the conclusion . OBJECTIVE:The study was undertaken to evaluate the clinical value,safety and operative complications of restaging surgery to patients with ovarian carcinoma . METHODS: After the extensive literature searched between January 1,2000 and December 31,2010,we reviewed all literatures about the restaging surgery to patients with ovarian carcinoma . RESULTS: 9 literatures(retrospective) were met the inclusion criteria .91(26%)out of the 351 patients who underwent restaging had their tumours upstaged or positive findings .Amond the 91 patients , 41 of them had their stage upstage to stageⅢdisease .6 literatures reported 112 positive sites in restaging surgery: pelvic and/or peritoneal tissue metastasis 40(36%), ascites and peritoneal washings cytology positive 24(21%),lymphnodes positive 19(17%),omentum metastasis 14(13%),diaphragm metastasis 15(13%). The complications of t restaging surgery was reported by 5 literatures .The common intraoperative morbidity included bleeding,injuries of bladder,ureter,intestines et al .And the common postoperative morbidity were infection,intestinal obstruction,lymphadenocyst et al .Only 1 literatures about the laparoscopic restaging surgery reported that evaluation blood loss was less than 300ml. No death related to surgery was reported . CONCLUSION:Restaging surgery could comprehensive staging of disease,and it was safety and morbidities were acceptable。...