A new policy regarding ovarian resection in young women treated for peritoneal carcinomatosis

Our plain-English summary of A new policy regarding ovarian resection in young women treated for peritoneal carcinomatosis, by D. Elias, E. Duchalais, P. Dartigues, et al (Annals of Surgical Oncology, 2013).

The study

• Authors: D. Elias, E. Duchalais, P. Dartigues, P. Duvillard, C. Poirot, D. Goéré
• Journal: Annals of Surgical Oncology
• Published: 2013;20(6):1837-42
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To appreciate if the ovaries can be preserved in selected young women with peritoneal carcinomatosis (PC).

Background: The traditional rule is to resect the ovaries systematically when PC is found at surgery.

Methods: A new policy was developed to preserve the ovaries when they were macroscopically normal in young women with PC of different origin who expressed a strong desire for future pregnancy.

Results: A total of 106 women younger than age 41 years underwent complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. At least one ovary was preserved in 29 % of them (and in 44 % of those who strongly wished future pregnancy). Among resected "normal" ovaries, 17 % were involved by tumor at the final pathologic examination. Among the resected "suspicious" ovaries, 38 % were involved. Among the 29 preserved ovaries (in 21 women), after a median follow-up of 32 months, 4 (14 %) developed ovarian recurrence, in 3 of them associated with other metastases. Two women became pregnant. In five women with partially normal ovary, egg harvesting and cryopreservation was performed.

Conclusions: This new policy allowed ovarian preservation in 44 % of the young women wishing childbearing and allowed two births. Recurrence in the preserved ovary was 14 % with our criteria of selection. This policy is promising but can be further improved.

In plain English

This French single-center article described a surgical policy for women younger than 41 with peritoneal carcinomatosis (cancer spread over the abdominal lining). All had complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, 1994 to 2012. Of 106 women, 13 had malignant mesothelioma. The others had colorectal cancer, pseudomyxoma peritonei or other tumors. The article did not discuss asbestos. The stated policy was to keep strictly normal-looking ovaries in women who strongly wished for pregnancy, with exceptions such as a needed hysterectomy or a single remaining ovary. Of 72 women who still had at least one ovary, 21 (29%) kept at least one, including 16 of the 36 (44%) who wished for pregnancy. Of removed ovaries that looked normal, 5 of 29 (17%) contained tumor. Of removed suspicious-looking ovaries, 5 of 13 (38%) did. Cancer returned in a preserved ovary in 4 of the 21 women. Two women became pregnant. None of the 3 women with mesothelioma who kept ovaries had a recurrence. The authors concluded the results were promising but could be improved.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center surgical case series analyzed from a prospectively built registry, describing the outcomes of a new ovarian-preservation policy
• Who was studied: 106 women younger than 41 years treated with complete cytoreductive surgery plus HIPEC at the authors' center (Institut Gustave Roussy, Villejuif, France), 1994 to 2012. Origin of peritoneal carcinomatosis: colorectal cancer 44, pseudomyxoma peritonei 33, malignant mesothelioma 13, miscellaneous 16. Primary cancers of the genital tract were excluded.
• Exposure: No asbestos or other environmental exposure was studied. What was studied was a surgical policy. As stated, ovaries were kept when they looked strictly normal in women who strongly wished to become pregnant. They were removed when they looked involved or suspicious, when hysterectomy was needed, when only one ovary remained after an earlier removal for tumor, or when the woman did not want a future pregnancy.
• Main results:
  • Of the 72 women with at least one ovary in place at surgery, at least one ovary was preserved in 21 (29%), and both ovaries were removed in 51 (71%). Of the 36 women who strongly wished for future pregnancy, 16 (44%) had ovarian preservation and 20 had bilateral oophorectomy.
  • Of 29 macroscopically normal ovaries that were removed (in 23 women), 5 (17%) were found to contain tumor on final pathology.
  • Of 16 normal-looking ovaries removed because the other ovary was invaded, 5 (31%) contained tumor.
  • Of 13 ovaries removed because they looked suspicious (tiny surface granulations or cysts), 5 (38%) contained tumor.
  • Recurrence in a preserved ovary occurred in 4 of the 21 women (19%): 3 with colorectal cancer and 1 with fibrolamellar hepatocellular carcinoma. This was 4 of the 29 preserved ovaries (14%). Three of these recurrences were accompanied by recurrence at other sites.
  • Among the 3 women with mesothelioma who had ovarian preservation, there were 0 recurrences (Table 2), with a median follow-up of 51 months.
  • Two women with at least one preserved ovary had successful pregnancies, at 26 and 62 months after surgery. One had low-grade pseudomyxoma and the other had endocrine carcinoma.
  • Five women had egg (ovocyte) harvesting with cryopreservation. Two of them later had the tissue grafted, and their menstruation returned. In vitro fertilization had not yet been done.
• The authors' conclusion: The authors concluded that these initial results of a policy of selective ovarian preservation in young women with peritoneal carcinomatosis were promising and could be further improved. They also said the risk of ovarian recurrence must be balanced against the possibility of childbearing.
• Limitations the authors state:
  • In women with pseudomyxoma peritonei, normal-looking ovaries contained tumor in 50% of cases. The authors said the policy will likely be modified for this group and that a more detailed analysis is needed and ongoing.
  • The pregnancies occurred after limited follow-up, and the results of the recommended policy were only beginning to be analysed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer, Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC.

Related studies

• Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking — S. Riss, K. Chandrakumaran, et al. (2015)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)

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