A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center team ovary initiative

• Published in: Gynecologic oncology 2020-09, Vol.158 (3), p.608-613
• Main Authors: Straubhar, Alli M., Filippova, Olga T., Cowan, Renee A., Lakhman, Yulia, Sarasohn, Debra M., Nikolovski, Ines, Torrisi, Jean M., Ma, Weining, Abu-Rustum, Nadeem R., Gardner, Ginger J., Sonoda, Yukio, Zivanovic, Oliver, Chi, Dennis S., Long Roche, Kara
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Ovarian Epithelial - drug therapy; Carcinoma, Ovarian Epithelial - pathology; Carcinoma, Ovarian Epithelial - surgery; Cytoreduction Surgical Procedures - methods; Cytoreductive outcomes; Female; Humans; Middle Aged; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Primary debulking surgery; Resectability score; Treatment Outcome; Triage - methods; Triage algorithm
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2020.05.041

To describe outcomes using a multimodal algorithm to triage patients with advanced epithelial ovarian cancer (EOC) to primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT). All patients with EOC treated at our institution from 04/2015–08/2018 were identified. We included patients without contraindication to PDS who underwent prospective calculation of a Resectability (R)-score. A low risk score for suboptimal cytoreduction was defined as ≤6, and a high risk score ≥7. Patients were triaged to laparotomy/PDS, laparoscopic evaluation of resectability (LSC), or NACT depending on R-score. Among 299 participants, 226 (76%) had a low risk score and 73 (24%) a high risk score. For patients with a low risk score, management included laparotomy/PDS, 181 (80%); LSC, 43 (19%) (with subsequent triage: PDS, 31; NACT, 12); and NACT, 2 (1%). For patients with a high risk score, management included laparotomy/PDS, 9 (12%); LSC, 51 (70%) (with subsequent triage: PDS, 28; NACT, 23); and NACT, 13 (18%). Overall, 83% underwent PDS, with a 75% CGR rate and 94% optimal cytoreduction rate. Use of the algorithm resulted in a 31% LSC rate and a 6% rate of suboptimal PDS. The multimodal algorithm led to excellent surgical results; 94% of patients achieved an optimal resection, with a very low rate of suboptimal cytoreduction. •A multimodal algorithm combining clinical and radiologic data with diagnostic laparoscopy for advanced ovarian cancer•A multimodal preoperative algorithm leads to precise resource utilization without compromising outcomes.•Excellent surgical outcomes with a modest utilization of diagnostic laparoscopy and a very low rate of futile laparotomy