Limited utility of conventional criteria for predicting unresectable disease in patients with advanced stage epithelial ovarian cancer

Objective: To evaluate the predictive value of conventional criteria for identifying surgically unresectable disease among patients with ovarian cancer undergoing initial operative intervention at tertiary referral centers employing a so-called aggressive approach to surgical cytoreduction. Methods: All patients with advanced epithelial ovarian cancer undergoing primary surgery between August 1997 and August 2006 were identified. Surgical/pathological documentation of disease extent pre/post-cytoreduction was extracted from the medical record retrospectively. All patients meeting conventional criteria for unresectable disease criteria (ascites> 1000 mL, omental extension to spleen > 1 cm, parenchymal liver disease > 1cm, porta hepatis involvement > 1 cm, diaphragmatic disease > 1 cm, carcinomatosis > 1 cm, and suprarenal adenopathy > 1 cm) were selected for further study. Results: A total of 180 consecutive patients had disease meeting conventional criteria for unresectability at = 1 site(s). Optimal cytoreduction (residual disease = 1 cm) was achieved in 166 patients (92.2%). Optimal resection rates according to the most common individual unresectable disease criteria were as follows: ascites > 1000 mL = 91.3% (116/127), carcinomatosis > 1 cm = 91.0% (81/89), and splenic involvement > 1 cm = 84.9% (45/53). For patients with ascites > 1000 mL alone, optimal cytoreduction was achieved in 95.8% (46/48) of cases. Optimal resection rates according to the total number of unresectable disease sites were as follows: 1 site = 95.0% (19/20), 2 sites = 93.8% (61/65), 3 sites = 81.5% (22/27), 4 sites = 93.3% (14/15), and 5 sites = 80.0% (4/5). Conclusions: These data suggest that commonly accepted criteria of surgically unresectable disease for women with advanced ovarian cancer lack the necessary precision to guide clinical management. Pre-operative assessment of resectability should be made by an experienced surgical team prior to deferring the initial attempt at surgical cytoreduction.