Optimal primary surgical treatment for advanced epithelial ovarian cancer.

Abstract:

BACKGROUND:Ovarian cancer is the sixth most common cancer among women. In addition to diagnosis and staging, primary surgery is performed to achieve optimal cytoreduction (surgical efforts aimed at removing the bulk of the tumour) as the amount of residual tumour is one of the most important prognostic factors for survival of women with epithelial ovarian cancer. An optimal outcome of cytoreductive surgery remains a subject of controversy to many practising gynae-oncologists. The Gynaecologic Oncology group (GOG) currently defines 'optimal' as having residual tumour nodules each measuring 1 cm or less in maximum diameter, with complete cytoreduction (microscopic disease) being the ideal surgical outcome. Although the size of residual tumour masses after surgery has been shown to be an important prognostic factor for advanced ovarian cancer, it is unclear whether it is the surgical procedure that is directly responsible for the superior outcome that is associated with less residual disease. OBJECTIVES:To evaluate the effectiveness and safety of optimal primary cytoreductive surgery for women with surgically staged advanced epithelial ovarian cancer (stages III and IV).To assess the impact of various residual tumour sizes, over a range between zero and 2 cm, on overall survival. SEARCH STRATEGY:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3) and the Cochrane Gynaecological Cancer Review Group Trials Register, MEDLINE and EMBASE (up to August 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA:Retrospective data on residual disease from randomised controlled trials (RCTs) or prospective and retrospective observational studies which included a multivariate analysis of 100 or more adult women with surgically staged advanced epithelial ovarian cancer and who underwent primary cytoreductive surgery followed by adjuvant platinum-based chemotherapy. We only included studies that defined optimal cytoreduction as surgery leading to residual tumours with a maximum diameter of any threshold up to 2 cm. DATA COLLECTION AND ANALYSIS:Two review authors independently abstracted data and assessed risk of bias. Where possible, the data were synthesised in a meta-analysis. MAIN RESULTS:There were no RCTs or prospective non-RCTs identified that were designed to evaluate the effectiveness of surgery when performed as a primary procedure in advanced stage ovarian cancer.We found 11 retrospective studies that included a multivariate analysis that met our inclusion criteria. Analyses showed the prognostic importance of complete cytoreduction, where the residual disease was microscopic that is no visible disease, as overall (OS) and progression-free survival (PFS) were significantly prolonged in these groups of women. PFS was not reported in all of the studies but was sufficiently documented to allow firm conclusions to be drawn.When we compared suboptimal (> 1 cm) versus optimal (< 1 cm) cytoreduction the survival estimates were attenuated but remained statistically significant in favour of the lower volume disease group There was no significant difference in OS and only a borderline difference in PFS when residual disease of > 2 cm and < 2 cm were compared (hazard ratio (HR) 1.65, 95% CI 0.82 to 3.31; and HR 1.27, 95% CI 1.00 to 1.61, P = 0.05 for OS and PFS respectively).There was a high risk of bias due to the retrospective nature of these studies where, despite statistical adjustment for important prognostic factors, selection bias was still likely to be of particular concern.Adverse events, quality of life (QoL) and cost-effectiveness were not reported by treatment arm or to a satisfactory level in any of the studies. AUTHORS' CONCLUSIONS:During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable, the surgical goal should be optimal (< 1 cm) residual disease. Due to the high risk of bias in the current evidence, randomised controlled trials should be performed to determine whether it is the surgical intervention or patient-related and disease-related factors that are associated with the improved survival in these groups of women. The findings of this review that women with residual disease < 1 cm still do better than women with residual disease > 1 cm should prompt the surgical community to retain this category and consider re-defining it as 'near optimal' cytoreduction, reserving the term 'suboptimal' cytoreduction to cases where the residual disease is > 1 cm (optimal/near optimal/suboptimal instead of complete/optimal/suboptimal).

authors

Elattar A,Bryant A,Winter-Roach BA,Hatem M,Naik R

doi

10.1002/14651858.CD007565.pub2

subject

Has Abstract

pub_date

2011-08-10 00:00:00

pages

CD007565

issue

8

issn

1469-493X

pub_type

杂志文章,meta分析,评审
  • Touch therapies for pain relief in adults.

    abstract:BACKGROUND:Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use. OBJECTIVES:...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006535.pub2

    authors: So PS,Jiang Y,Qin Y

    更新日期:2008-10-08 00:00:00

  • Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy.

    abstract:BACKGROUND:Febrile neutropenia (FN) and other infectious complications are some of the most serious treatment-related toxicities of chemotherapy for cancer, with a mortality rate of 2% to 21%. The two main types of prophylactic regimens are granulocyte (G-CSF) or granulocyte-macrophage colony stimulating factors (GM-CS...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007107.pub2

    authors: Herbst C,Naumann F,Kruse EB,Monsef I,Bohlius J,Schulz H,Engert A

    更新日期:2009-01-21 00:00:00

  • Corticosteroids for parasitic eosinophilic meningitis.

    abstract:BACKGROUND:Angiostrongylus cantonensis (A. cantonensis) is the major cause of infectious eosinophilic meningitis. Dead larvae of this parasite cause inflammation and exacerbate symptoms of meningitis. Corticosteroids are drugs used to reduce the inflammation caused by this parasite. OBJECTIVES:To assess the efficacy a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009088.pub3

    authors: Thanaviratananich S,Thanaviratananich S,Ngamjarus C

    更新日期:2015-02-17 00:00:00

  • Alternative agents versus prophylactic platelet transfusion for preventing bleeding in patients with haematological disorders after chemotherapy or stem cell transplantation.

    abstract::This is the protocol for a review and there is no abstract. The objectives are as follows: To determine whether alternative agents (e.g. artificial platelet substitutes, platelet-poor plasma, fibrinogen, rFVIIa, thrombopoietin mimetics) are as effective and safe as the use of platelet transfusions for the prevention o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD010982

    authors: Estcourt LJ,Gregg R,Stanworth S,Doree C,Trivella M,Murphy MF,Tinmouth A

    更新日期:2014-01-01 00:00:00

  • Antigen-specific active immunotherapy for ovarian cancer.

    abstract:BACKGROUND:Despite advances in chemotherapy, prognosis of ovarian cancer remains poor. Antigen-specific active immunotherapy aims to induce tumour-antigen-specific anti-tumour immune responses as an alternative treatment for ovarian cancer. OBJECTIVES:To assess the feasibility of antigen-specific active immunotherapy ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007287.pub3

    authors: Leffers N,Daemen T,Helfrich W,Boezen HM,Cohlen BJ,Melief CJ,Nijman HW

    更新日期:2014-09-17 00:00:00

  • Interventions for replacing missing teeth: 1- versus 2-stage implant placement.

    abstract:BACKGROUND:Implants may be placed penetrating the oral mucosa (1-stage procedure) or can be completely buried under the oral mucosa (2-stage procedure) during the healing phase of the bone at the implant surface. With a 2-stage procedure the risk of having unwanted loading onto the implants is minimized, but a second m...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006698.pub2

    authors: Esposito M,Grusovin MG,Chew YS,Coulthard P,Worthington HV

    更新日期:2009-07-08 00:00:00

  • Interventions for treating fractures of the patella in adults.

    abstract:BACKGROUND:Fractures of the patella (kneecap) account for around 1% of all human fractures. The treatment of these fractures can be surgical or conservative (such as immobilisation with a cast or brace). There are many different surgical and conservative interventions for treating fractures of the patella in adults. O...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009651.pub2

    authors: Sayum Filho J,Lenza M,Teixeira de Carvalho R,Pires OG,Cohen M,Belloti JC

    更新日期:2015-02-27 00:00:00

  • Treatments for breast engorgement during lactation.

    abstract:BACKGROUND:Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consis...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD006946.pub4

    authors: Zakarija-Grkovic I,Stewart F

    更新日期:2020-09-18 00:00:00

  • Antibiotics versus control for toxoplasma retinochoroiditis.

    abstract:BACKGROUND:Acute toxoplasma retinochoroiditis causes transient symptoms of ocular discomfort and may lead to permanent visual loss. Antibiotic treatment primarily aims to reduce the risk of permanent visual loss, recurrent retinochoroiditis, and the severity and duration of acute symptoms. There is uncertainty about th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002218

    authors: Gilbert RE,See SE,Jones LV,Stanford MS

    更新日期:2002-01-01 00:00:00

  • Decision aids for people facing health treatment or screening decisions.

    abstract:BACKGROUND:Decision aids are interventions designed to help people make specific and deliberative choices among options (including status quo) by providing (at a minimum) information on the options and outcomes relevant to a person's health status. A systematic review is needed to summarize what is known about their ef...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001431

    authors: O'Connor AM,Stacey D,Rovner D,Holmes-Rovner M,Tetroe J,Llewellyn-Thomas H,Entwistle V,Rostom A,Fiset V,Barry M,Jones J

    更新日期:2001-01-01 00:00:00

  • The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.

    abstract:BACKGROUND:This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003162.pub3

    authors: Hilton MP,Pinder DK

    更新日期:2014-12-08 00:00:00

  • Magnesium sulphate versus diazepam for eclampsia.

    abstract:BACKGROUND:Eclampsia, the occurrence of a convulsion in association with pre-eclampsia, remains a rare but serious complication of pregnancy. A number of different anticonvulsants are used to control eclamptic fits and to prevent further fits. OBJECTIVES:The objective of this review was to assess the effects of magnes...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000127

    authors: Duley L,Henderson-Smart D

    更新日期:2003-01-01 00:00:00

  • Therapeutic touch for healing acute wounds.

    abstract:BACKGROUND:Therapeutic Touch (TT) is an alternative therapy that has gained popularity over the past two decades for helping wounds to heal. Practitioners enter a meditative state and pass their hands above the patient's body to find and correct any imbalances in the patient's 'life energy' or chi. Scientific instrumen...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002766.pub4

    authors: O'Mathúna DP

    更新日期:2016-05-03 00:00:00

  • Sports and games for post-traumatic stress disorder (PTSD).

    abstract:BACKGROUND:Traumatic experiences evoke emotions such as fear, anxiety and distress and may encourage avoidance of similar situations in the future. For a proportion of those exposed to a traumatic event, this emotional reaction becomes uncontrollable and can develop into Post Traumatic Stress Disorder (PTSD) (Breslau 2...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007171.pub2

    authors: Lawrence S,De Silva M,Henley R

    更新日期:2010-01-20 00:00:00

  • Aerobic physical exercise for adult patients with haematological malignancies.

    abstract:BACKGROUND:Although people with haematological malignancies have to endure long phases of therapy and immobility, which is known to diminish their physical performance level, the advice to rest and avoid intensive exercises is still common practice. This recommendation is partly due to the severe anaemia and thrombocyt...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD009075.pub3

    authors: Knips L,Bergenthal N,Streckmann F,Monsef I,Elter T,Skoetz N

    更新日期:2019-01-31 00:00:00

  • Intramedullary nails for extracapsular hip fractures in adults.

    abstract:BACKGROUND:Intramedullary nails may be used for the surgical fixation of extracapsular hip fractures in adults. They may be inserted from the top (cephalocondylic) or from the bottom (condylocephalic) end of the femur. OBJECTIVES:To compare different types or design modifications of intramedullary nails used in the fi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004961.pub3

    authors: Parker MJ,Handoll HH

    更新日期:2006-07-19 00:00:00

  • Directly observed therapy for treating tuberculosis.

    abstract:BACKGROUND:Up to half the people with tuberculosis do not complete their treatment. Thus strategies that improve adherence to treatment regimens are important. OBJECTIVES:To compare policies of directly observed therapy with self treatment at home in people requiring treatment for clinically active tuberculosis, or re...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003343

    authors: Volmink J,Garner P

    更新日期:2003-01-01 00:00:00

  • Motivational interviewing for smoking cessation.

    abstract:BACKGROUND:Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to quit smoking. OBJECTIVES:To determin...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006936.pub3

    authors: Lindson-Hawley N,Thompson TP,Begh R

    更新日期:2015-03-02 00:00:00

  • Interventions for cough in cancer.

    abstract:BACKGROUND:Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it. OBJECTIVES:The primary objective of this review was to determine the effectiveness of interventions, bot...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007881.pub2

    authors: Molassiotis A,Bailey C,Caress A,Brunton L,Smith J

    更新日期:2010-09-08 00:00:00

  • Physical measures for treating depression in dialysis patients.

    abstract:BACKGROUND:Depression is the most common psychological problem in the chronic dialysis population. The diagnosis of depression in patients on chronic dialysis is confounded by the fact that several symptoms of uraemia mimic the somatic components of depression. It affects their physical, psychological and social well-b...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004541.pub2

    authors: Rabindranath KS,Butler JA,Macleod AM,Roderick P,Wallace SA,Daly C

    更新日期:2005-04-18 00:00:00

  • Magnesium sulfate for treating exacerbations of acute asthma in the emergency department.

    abstract:BACKGROUND:Treatment of acute asthma is based on rapid reversal of bronchospasm and arresting airway inflammation. There is some evidence that intravenous magnesium can provide additional bronchodilation when given in conjunction with standard bronchodilating agents and corticosteroids. No systematic review of this lit...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001490

    authors: Rowe BH,Bretzlaff JA,Bourdon C,Bota GW,Camargo CA Jr

    更新日期:2000-01-01 00:00:00

  • Exercise interventions for upper-limb dysfunction due to breast cancer treatment.

    abstract:BACKGROUND:Upper-limb dysfunction is a commonly reported side effect of treatment for breast cancer and may include decreased shoulder range of motion (the range through which a joint can be moved) (ROM) and strength, pain and lymphedema. OBJECTIVES:To review randomized controlled trials (RCTs) evaluating the effectiv...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005211.pub2

    authors: McNeely ML,Campbell K,Ospina M,Rowe BH,Dabbs K,Klassen TP,Mackey J,Courneya K

    更新日期:2010-06-16 00:00:00

  • Pharmacological treatment for Buerger's disease.

    abstract:BACKGROUND:Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small and medium sized arteries, veins, and nerves in the upper and lower extremities. The aetiology is unknown, but involves hereditary susceptibility, tobacco exposure, i...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD011033.pub4

    authors: Cacione DG,Macedo CR,do Carmo Novaes F,Baptista-Silva JC

    更新日期:2020-05-04 00:00:00

  • Carbohydrate supplementation of human milk to promote growth in preterm infants.

    abstract:BACKGROUND:Preterm infants are born with low glycogen stores and require higher glucose intake to match fetal accretion rates. In spite of the myriad benefits of breast milk for preterm infants, it may not adequately meet the needs of these rapidly growing infants. Supplementing human milk with carbohydrates may help. ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD000280.pub3

    authors: Amissah EA,Brown J,Harding JE

    更新日期:2020-09-08 00:00:00

  • Glutamine supplementation to prevent morbidity and mortality in preterm infants.

    abstract:BACKGROUND:Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also bene...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001457.pub5

    authors: Moe-Byrne T,Brown JV,McGuire W

    更新日期:2016-01-12 00:00:00

  • Audio recordings of consultations with doctors for parents of critically sick babies.

    abstract:BACKGROUND:Family centred care is an important part of neonatal intensive care. Ensuring effective communication in the neonatal intensive care unit (NICU) is a challenge but is crucial to the implementation of family centred care. Providing parents in NICU with audiotape recordings of their conversations with neonatol...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004502.pub2

    authors: Koh TH,Budge D,Butow P,Renison B,Woodgate P

    更新日期:2005-01-25 00:00:00

  • Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion.

    abstract:BACKGROUND:Branch retinal vein occlusion (BRVO) is one of the most common occurring retinal vascular abnormalities. The pathogenesis of BRVO is thought to involve both retinal vein compression and damage to the vessel wall, possibly leading to thrombus formation at sites where retinal arterioles cross retinal veins. Th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009510.pub2

    authors: Mitry D,Bunce C,Charteris D

    更新日期:2013-01-31 00:00:00

  • Topical negative pressure for treating chronic wounds.

    abstract:BACKGROUND:Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure (TNP) is u...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001898.pub2

    authors: Ubbink DT,Westerbos SJ,Evans D,Land L,Vermeulen H

    更新日期:2008-07-16 00:00:00

  • Risedronate for the prevention and treatment of postmenopausal osteoporosis.

    abstract:BACKGROUND:Postmenopausal osteoporosis results in an increased susceptibility to low-trauma fractures due to reduced bone volume and microarchitectural deterioration. Risedronate, a third generation bisphosphonate, has been shown in multiple clinical trials to reduce fracture risk and improve bone mineral density in po...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004523

    authors: Cranney A,Waldegger L,Zytaruk N,Shea B,Weaver B,Papaioannou A,Robinson V,Wells G,Tugwell P,Adachi JD,Guyatt G

    更新日期:2003-01-01 00:00:00

  • Intra-articular corticosteroid for knee osteoarthritis.

    abstract:BACKGROUND:Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intra-articular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. OBJECTIVES:To deter...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005328.pub3

    authors: Jüni P,Hari R,Rutjes AW,Fischer R,Silletta MG,Reichenbach S,da Costa BR

    更新日期:2015-10-22 00:00:00