Thoracic surgery for ovarian cancer recurrence

Abstract

Aim. Safety, efficiency and diagnostic value of diagnostic and curative thoracic surgical interventions were the objectives of current research dedicated to patients with recurrent ovarian cancer. Materials and Methods. Retrospective analysis of medical records of patients with recurrent ovarian cancer, on whom surgical interventions were performed at the State Establishment "Zaitsev V.T. Institute of General and Emergency Surgery of the Academy of Medical Sciences of Ukraine" during January 2010 - December 2015. Recurrence localization was limited by the organs of the thoracic cavity. Both diagnostic and cytoreductive surgical interventions were taken into account. Results and Discussion. Forty three patients met the search criteria. In 11 cases (26%) more than one thoracic localization was diagnosed. Thoracoscopy (n=36; 84%) allows to assess the state of parietal and visceral pleura, to perform the dissection of pleural conjunctions, to determine the extension of pleural involvement and to take a biopsy from its surface. Possibility and feasibility of partial pleverectomy was established thoracoscopically (n=7, 16%). Pleurodesis (n=16; 37%) was performed in order to stop malignant recurrent pleural effusion. Pleurodesis effectiveness: complete remission (n=11; 69%); partial remission (n=4; 25%); progression of the disease (n=1; 6%). Mediastinoscopy was performed in 18 patients (42%) with radiological signs of mediastinal lymphadenopathy. In 12 cases (28%) cancer etiology had been confirmed and further lymphadenectomy was performed. In other cases (n=6; 14%), lymphadenopathy was not malignant with no subsequent surgery. Surgeries for lung parenchyma were the following: atypical lung resection (n=17, 40%), segmentectomy (n=3, 7%), lobectomy (n=2, 5%). Postoperative complications and mortality were 9% (n=4) and 2% (n=1), respectively. Median overall survival for patients with the duration of recurrence-free period 24 months - 48 months (p<0.05). Isolated parenchymal or lymph nodes lesions were characterized by the most favorable prognosis. The median overall survival rate for lung parenchyma recurrence was 39 months, lymph nodes - 31 months, pleura - 13 months, with more than one localization - 8 months (p<0.05). Conclusions. Recurrent ovarian cancer with of thoracic organs, traditionally, is not considered from the perspective of surgical treatment. Diagnostic surgical interventions allow individualizing treatment. Secondary cytoreduction procedures are safe and do not affect the timing of adjuvant treatment. They are characterized by a positive effect on overall and recurrence-free survival, compared to chemotherapy treatment. The duration of the recurrence-free period affects the median survival after secondary cytoreduction. Isolated lung parenchyma lesion is characterized by the most favorable prognosis. Taking into account the high frequency of the chest cavity lesions in patients with ovarian cancer recurrence, not only the palliative care, but also the development of indications for cytoreductive surgery remains important, as a way to prolong survival.

Keywords

• ovarian cancer, recurrence, surgery, secondary cytoreduction, organs of the chest cavity