Meigs to modern times: The evolution of debulking surgery in advanced ovarian cancer.

Joe V. Meigs was a visionary clinician and an early adopter of radical techniques in the surgical treatment of ovarian cancer. His 1934 textbook "Tumors of the Female Pelvic Organs", consolidated his approach to this "hopeless" disease, with pearls on diagnosis, outcomes, and even speculations about the benefits of minimally invasive surgery. Decades before adjuvant chemotherapy would prove of value, and in an era when sophisticated statistics were unheard of, he nonetheless tried to eke out what benefits he could using the methods available in his time. We transition his original findings and observations through the advent of platinum-based chemotherapy, retrospective cohort studies supporting the benefits of primary debulking, and finally the long-awaited randomized controlled trial. We aim to provide historical context for the underpinnings of how cytoreductive surgery has evolved into its current role in the treatment of advanced ovarian cancer.

[1]  N. Aaronson,et al.  Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer , 2018, The New England journal of medicine.

[2]  P. Gehrig,et al.  Surgical readmission and survival in women with ovarian cancer: Are short-term quality metrics incentivizing decreased long-term survival? , 2017, Gynecologic oncology.

[3]  M. Birrer,et al.  Clinicopathologic characteristics associated with long-term survival in advanced epithelial ovarian cancer: an NRG Oncology/Gynecologic Oncology Group ancillary data study. , 2017, Gynecologic oncology.

[4]  C. Ngô,et al.  A pre-operative predictive score to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer , 2017, PloS one.

[5]  J. Garrett,et al.  Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival. , 2017, Gynecologic oncology.

[6]  D. Chi,et al.  Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care. , 2017, Gynecologic oncology.

[7]  J. Schorge,et al.  Laparoscopy Compared With Laparotomy for Debulking Ovarian Cancer After Neoadjuvant Chemotherapy. , 2017, Obstetrics and gynecology.

[8]  I. Zighelboim,et al.  The role of neoadjuvant chemotherapy in the management of patients with advanced stage ovarian cancer: Survey results from members of the society of gynecologic oncologists, a 5-year follow-up , 2017, Gynecologic oncology reports.

[9]  J. Schorge,et al.  Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States. , 2016, Gynecologic oncology.

[10]  D. Levine,et al.  Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center. , 2016, Gynecologic oncology.

[11]  G. Scambia,et al.  Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: proof of a concept. , 2015, Gynecologic oncology.

[12]  H. Kitchener,et al.  Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial , 2015, The Lancet.

[13]  J. Schorge,et al.  Primary debulking surgery for advanced ovarian cancer: are you a believer or a dissenter? , 2014, Gynecologic oncology.

[14]  H. Hricak,et al.  A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. , 2014, Gynecologic oncology.

[15]  G. Scambia,et al.  Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. , 2013, Gynecologic oncology.

[16]  F. Ghezzi,et al.  A multicentric trial (Olympia-MITO 13) on the accuracy of laparoscopy to assess peritoneal spread in ovarian cancer. , 2013, American journal of obstetrics and gynecology.

[17]  J. Schorge,et al.  Patient, treatment and discharge factors associated with hospital readmission within 30 days after surgical cytoreduction for epithelial ovarian carcinoma. , 2013, Gynecologic oncology.

[18]  J. Meigs,et al.  Tumors of the Female Pelvic Organs , 2013 .

[19]  H. Ryu,et al.  Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer , 2012, Annals of Surgical Oncology.

[20]  R. Bristow,et al.  Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining 'optimal' residual disease. , 2012, Gynecologic oncology.

[21]  P. Bossuyt,et al.  Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study , 2012, BMC Cancer.

[22]  M. Spillman,et al.  Surgical Risk Score Predicts Suboptimal Debulking or a Major Perioperative Complication in Patients With Advanced Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer , 2011, International Journal of Gynecologic Cancer.

[23]  D. Lorenz,et al.  Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. , 2011, Gynecologic oncology.

[24]  J. Schorge,et al.  Prognostic Significance of Splenectomy as Part of Initial Cytoreductive Surgery in Ovarian Cancer , 2011, Annals of Surgical Oncology.

[25]  F. Amant,et al.  Neoadjuvant chemotherapy in advanced ovarian cancer: what kind of evidence is needed to convince US gynaecological oncologists? , 2010, Gynecologic oncology.

[26]  G. Kenter,et al.  Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. , 2010, The New England journal of medicine.

[27]  D. Levine,et al.  Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. , 2009, Gynecologic oncology.

[28]  W. Cliby,et al.  Quality improvement in the surgical approach to advanced ovarian cancer: the Mayo Clinic experience. , 2009, Journal of the American College of Surgeons.

[29]  G. Scambia,et al.  Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. , 2008, American journal of obstetrics and gynecology.

[30]  R. Rouzier,et al.  External validation of a laparoscopic-based score to evaluate resectability of advanced ovarian cancers: clues for a simplified score. , 2008, Gynecologic oncology.

[31]  Carol L. Brown,et al.  Prospective study of the correlation between postoperative computed tomography scan and primary surgeon assessment in patients with advanced ovarian, tubal, and peritoneal carcinoma reported to have undergone primary surgical cytoreduction to residual disease 1 cm or less. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[32]  D. Chi,et al.  A new frontier for quality of care in gynecologic oncology surgery: multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. , 2007, Gynecologic oncology.

[33]  R. Ozols,et al.  Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[34]  D. Levine,et al.  What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC) , 2006 .

[35]  G. Scambia,et al.  A Laparoscopy-Based Score To Predict Surgical Outcome in Patients With Advanced Ovarian Carcinoma: A Pilot Study , 2006, Annals of Surgical Oncology.

[36]  W. Cliby,et al.  Aggressive Surgical Effort and Improved Survival in Advanced-Stage Ovarian Cancer , 2006, Obstetrics and gynecology.

[37]  R. Burger,et al.  Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study , 2005, BMJ : British Medical Journal.

[38]  G. Bifulco,et al.  Role of laparoscopy to assess the chance of optimal cytoreductive surgery in advanced ovarian cancer: a pilot study. , 2005, Gynecologic oncology.

[39]  N. Spirtos,et al.  Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. , 2003, Gynecologic oncology.

[40]  E. Trimble,et al.  Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[41]  A. Covens.  A critique of surgical cytoreduction in advanced ovarian cancer. , 2000, Gynecologic oncology.

[42]  J. Berek,et al.  The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. , 1994, American journal of obstetrics and gynecology.

[43]  N. Alexander,et al.  Meta-analysis of surgery in advanced ovarian carcinoma: is maximum cytoreductive surgery an independent determinant of prognosis? , 1992, American journal of obstetrics and gynecology.

[44]  J. Blythe,et al.  Debulking surgery: does it increase the quality of survival? , 1982, Gynecologic oncology.

[45]  Griffiths Ct.  Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. , 1975 .

[46]  C. Griffiths,et al.  Advanced ovarian cancer: Primary treatment with surgery, radiotherapy, and chemotherapy , 1972, Cancer.

[47]  B. Drukker,et al.  Ovarian carcinoma--perspective for the 70's. , 1971, American journal of obstetrics and gynecology.

[48]  Feroze Rm.  The pathology, diagnosis and management of malignant tumours of the ovary , 1971 .

[49]  P. Kolstad,et al.  Clinical and Histologic Studies of Ovarian Carcinoma: Long - Term Follow - Up of 990 Cases , 1971, Obstetrics and gynecology.

[50]  J. Meigs.  The surgical treatment of cancer of the ovary. , 1961, Clinical obstetrics and gynecology.

[51]  R. Rundles,et al.  Mustard chemotherapy in ovarian carcinoma. , 1959, Annals of Internal Medicine.

[52]  H. Taylor,et al.  Treatment and prognosis in cancer of the ovary, with a review of a new series of 143 cases treated in the years 1944-1951. , 1957, American journal of obstetrics and gynecology.

[53]  H. Ulfelder,et al.  The Surgery of Advanced Pelvic Cancer in Women , 1952 .

[54]  J. Meigs,et al.  Carcinoma of the ovary: clinical and pathological evaluation. , 1951, The New England journal of medicine.

[55]  J. Meigs.  CANCER OF THE OVARY , 1937 .

[56]  D. Mutch,et al.  Predictive modeling for determination of microscopic residual disease at primary cytoreduction: An NRG Oncology/Gynecologic Oncology Group 182 Study. , 2018, Gynecologic oncology.

[57]  N. Keating,et al.  Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer: Analysis of the National Cancer Database , 2017, JAMA oncology.

[58]  F. Amant,et al.  Primary surgery or neoadjuvant chemotherapy in ovarian cancer: what is the value of comparing apples with oranges? , 2012, Gynecologic oncology.

[59]  D. Levine,et al.  An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). , 2012, Gynecologic oncology.

[60]  N. Spirtos,et al.  Gynecologic Oncology Group Surgical Procedures Manual , 2009 .

[61]  C. Griffiths.  Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. , 1975, National Cancer Institute monograph.

[62]  R. Feroze.  The pathology, diagnosis and management of malignant tumours of the ovary. , 1971, Annals of the Royal College of Surgeons of England.