Eliminating tumor cell entrapment from the natural history of ovarian cancer, a narrative summary

Abstract

Objective: The surgery performed on patients with abdominal or pelvic malignancy has a profound effect on the natural history of that disease process. In this manuscript we examine the impact of hysterectomy performed in patients with ovarian cancer. Methods: Two assessment tools were reviewed to quantitate the changes induced by hysterectomy on the patterns of recurrence. The prior surgical score (PSS) correlates the survival of patients with the extent of surgery that was performed prior to cytoreductive surgery (CRS). Also, an assessment of anatomic sites of disease documented at the time of CRS for recurrent ovarian cancer determined the extent of tumor cell entrapment (TCE) at sites of surgical trauma. Results: Patients with recurrence of ovarian malignancy who had a CRS plus hyperthermic intraperitoneal chemotherapy (HIPEC) showed a statistically significant reduced survival if they had a high PSS. The data from TCE assessment showed that the sites of surgical trauma that occurred with hysterectomy performed for treatment of the primary ovarian cancer was associated with disease within the abdominal incision, laparoscopy port sites, and the resection site for hysterectomy. Conclusions: Hysterectomy performed in patients with stage 3 ovarian malignancy who have large numbers of free cancer cells within the abdominal and pelvic space had a profound effect upon the natural history of this malignancy as determined by PSS and an assessment of anatomic sites of TCE. HIPEC was suggested as a treatment to reduce the reimplantation of cancer cells at sites of surgical trauma following hysterectomy.