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  • br MONTH American Journal of Obstetrics Gynecology e br Orig

    2019-10-21


    MONTH 2019 American Journal of Obstetrics & Gynecology 1.e1
    Original Research
    GYNECOLOGY
    ajog.org
    AJOG at a Glance
    diameter of largest residual tumor
    Why was this Cucurbitacin I study conducted?
    nodule) were separated into 2 groups to
    The current de fi nition of “optimal” in patients undergoing interval debulking approximate volume of residual disease,
    distinguished by 1 cm greatest diam-
    surgery is defined as largest diameter of disease measuring 1.0 cm, independent
    of the total volume of disease.
    eter of residual disease confined to a
    Key findings
    single anatomic location ( 1 cm-SL)
    Complete surgical resection after interval debulking surgery is associated with and 1 cm greatest diameter of resid-
    ual disease involving multiple anatomic
    longest survival in advanced-stage ovarian cancer; however, single-anatomic locations ( 1 cm-ML). In cases in which
    location, low-volume residual may be an alternative goal when complete surgi-
    there were multiple tumor nodules
    cal resection is unattainable. In fact, 1 cm residual disease in multiple anatomic involving a single anatomic location, this
    locations confers similar oncologic outcomes to suboptimal debulking. was coded as single location disease,
    What does this add to what is known?
    given the
    difficulty
    in defining a
    measurable volume of disease in this
    These findings suggest that when complete surgical resection is not attainable
    setting. For example, a patient with a
    because of patient related or disease related factors, achieving low-volume single-
    anatomic location residual disease may provide an appropriate alternative.
    Similarly, a patient with multiple 1-
    cm nodules on the bowel mesentery was
    suggesting that “optimal” can be better their operative report, or had incomplete coded as 1 cm-SL, because the bowel
    de fi ned by considering both volume and medical records (n¼1). Decision to un- mesentery was one of our predefined
    15 Build- anatomic locations. Anatomic locations
    distribution of residual disease.
    dergo NACT, rather than PDS, was based
    ing on our previous findings, the goal of on surgeon discretion after an evaluation included
    the diaphragm, upper
    the current study was to evaluate the of disease burden and fitness for radical abdomen (excluding the diaphragm),
    impact of volume and distribution of surgery. Neoadjuvant chemotherapeutic pelvis, bowel serosa, bowel mesentery,
    residual disease on oncologic outcomes regimens were platinum- and taxane- pelvic and/or para-aortic lymph nodes,
    among patients managed with NACT- based and administered per standard- and abdominal peritoneum.
    IDS and to determine whether patients ized protocols during the study period. Differences in clinical, surgical, and
    with low-volume macroscopic disease The intent of neoadjuvant treatment was histopathologic factors between these 4
    still benefited from IDS.
    3e4 cycles of chemotherapy before IDS. patient groups were examined with the
    Materials and Methods
    chemotherapy, patients underwent appropriate. A P value <.05 was
    After we obtained institutional review computed tomography scan to deter- considered statistically significant. Sur-
    board approval, a retrospective chart mine whether residual disease volume vival analysis for the 4 patient groups
    review was conducted of all patients at appeared resectable. If deemed unre- included progression-free survival
    Brigham and Women’s Hospital and sectable, patients received additional (PFS) and OS. PFS was defined as the
    Massachusetts General Hospital under- cycles of chemotherapy at that time. All