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Ilvars Silins

Senior Consultant

Cytoreductive surgery, Department of Colorectal Surgery and Department of Gynecology

University Hospital of Uppsala, Sweden



Prognostic Importance of Complications after Primary or Interval Cytoreductive Surgery in Advanced Stage Ovarian Cancer


Macroscopically radical surgery is the goal of ovarian cancer treatment. Relapse-free and overall survival are much shorter if residual tumor exceeds even 1 mm during primary debulking surgery (PDS) or interval debulking surgery (IDS).
This study included 208 patients with primary ovarian cancer stage IIB-IVB and 41 patients with relapsed ovarian cancer treated between 2009 and 2017 at the Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden. PDS was performed in 129 patients (62%), and NACT with subsequent IDS in 79 patients (38%). Complete cytoreduction, CC-0, was achieved in 155 (74,5%) cases. CC-1 was achieved in 35 patients (16,8%).
Median overall survival after PDS with CC-0 was 79 months compared to 45 months after PDS with CC-1, and 37 months after IDS with CC-0.
We analyzed the risk for high-grade 3-4 morbidity (Clavien-Dindo classification of surgical complications) within 30 days after cytoreductive surgery by evaluating the impact of patient-, disease- and surgery-related factors.
Class 3a to 5 morbidity was observed in 60 (24,1%) of 249 analyzed patients. The incidence of high-grade morbidity decreased from 41% to 17% when comparing 2009-2013 versus 2014-2017.
Platelet count, albumin concentration, PCI (peritoneal carcinomatosis index) exceeding 20, CC-0, large bowel resection including colectomy and SCS (surgical complexity score) exceeding 8 were significant risk factors in univariate analysis. High-grade morbidity class 3-4 did not influence overall survival (p=0,47). In the multivariate analysis, platelet count remained an independent factor for overall survival (HR 9,25; 95% CI 1,74 to 49,21), while albumin concentration (p=0,086) and large bowel resection (p=0.07) tended to influence survival.




2001 -  2004           Post-doctoral fellow in Malmö University hospital/University of Lund
December 2001       Philosophy Doctor of Medicine (Ph.D.) degree awarded by the Karolinska Institutet for the thesis “Molecular epidemiology of Human Papillomavirus and cervical cancer”
September 2000      Medical Licentiate degree (Med. Lic.) awarded by the Karolinska Institutet for the thesis ¨Epidemiological studies of transmission and oncogenicity of sexually transmitted virus infections¨
1998-2001              Karolinska Institute Research and Training program (KIRT) – graduate student. Project ¨Molecular and clinical epidemiology of cervical carcinoma¨

1997 - 2000            Postgraduate studies in obstetrics & gynaecology and oncogynaecology
1994 - 1997            Postgraduate studies in oncology
1988 - 1994            Medical studies at the Medical Academy of Latvia Faculty of General Medicine (M.D. in 1994)
2001                Specialist in gynecologic oncology, Riga, Latvia

2000                Specialist in oncology and obstetrics & gynecology, Riga, Latvia


2014-                Senior Consultant, Cytoreductive surgery, Department of Colorectal Surgery and Department of Gynecology, University Hospital of Uppsala, Sweden

2012-2014       Senior Consultant, Head of Gynecologic-Oncology Surgery, Uppsala Cancer Clinic, Uppsala, Sweden

2009-2012       Senior Consultant, Tumor Surgery, Department of Gynecology, University Hospital of Uppsala, Sweden

2004-2009       Senior Consultant, Tumour Surgery, Department of Gynaecologic Oncology, Norwegian Radium Hospital, Oslo, Norway

2001-    2004    Post-doctoral fellow in Malmö University Hospital/University of Lund

1994-2001       Department of Gynaecologic Oncology, Oncology Center of Latvia, Riga, Latvia

1) I. Silins, Z. Wang, E. Åvall-Lundqvist, B. Frankendal, U. Vikmanis, M. Sapp, J.T. Schiller, J. Dillner. Serological evidence for protection by human papillomavirus (HPV) type 6 infection against HPV type 16 in cervical carcinogenesis. Journal of General Virology 1999 Nov; 80 (Pt 11): 2931-6

2) I. Silins and J. Dillner. Interaction between Human Papillomavirus types in cervical carcinogenesis. Papillomavirus Report, 11: 49-52 (2000)

3) R. Tedeschi, L. Caggiari, I. Silins, I. Kallings, A. Andersson-Ellström, P. De Paoli, J. Dillner. Seropositivity to human herpesvirus 8 in relation to sexual history and risk of sexually transmitted infections. International Journal of Cancer 2000 Jul 15; 87 (2): 232-5

4) I. Silins, I. Kallings, J. Dillner. Correlates of spread of human papillomavirus infection. Cancer Epidemiology, Biomarkers & Prevention 2000 Sep; 9(9): 953-9

5) I. Silins, R. Tedeschi, I. Kallings, J. Dillner. Clustering of seropositivities for Sexually Transmitted Infections. Sexually Transmitted Diseases, 2002 Apr; 29(4): 207-11

6) I. Silins, E. Avall-Lundqvist, K. Zumbach, J. Dillner, U. Stendahl, P. Lenner, B. Frankendal. Evaluation of antibodies to Human Papillomavirus: prognostic markers in cervical cancer patients. Gynecologic Oncology, 2002 May; 85(2): 333-8

7) I. Silins, X. Wang, A. Tadesse, K.U. Jansen, J.T. Schiller, E. Avall-Lundqvist, B. Frankendal, J. Dillner. A population-based study of cervical cancer and HPV infection in Latvia. Gynaecologic Oncology, 2004 May; 93: 484-492

8) I. Silins, W. Ryd, A. Strand, G. Wadell, S. Törnberg, B.G. Hansson, X. Wang, L. Arnheim,  V. Dahl, D. Bremell, K. Persson, J. Dillner and E. Rylander.
Chlamydia trachomatis infection and Human Papillomavirus persistence: A population-based cohort study. International Journal of Cancer, 2005 Aug 10;116(1):110-5.

9) K. Elfgren, E. Rylander, T. Rådberg, B. Strander, A. Strand, K. Paajanen, I. Sjöberg, W. Ryd, I. Silins and J. Dillner. Colposcopic and histopathologic findings in women participating in population-based screening for HPV DNA persistence. American Journal of Obstetrics and Gynecology, 2005 Sep;193(3 Pt 1):650-7.

10) H.P.Dong, M.B. Elstrand, A. Holth, I. Silins, A. Berner, C.G. Trope, B. Davidson, B. Risberg. NK- and B-cell infiltration correlates with worse outcome in metastatic ovarian carcinoma. Am J Clin Pathol 2006 Mar; 125(3):451-8

11) S. Elloul, I, Silins, C.G. Trope, A. Benshushan, B. Davidson, R. Reich. Expression of E-cadherin transcriptional regulators in ovarian carcinoma. Virchows Arch. 2006 Nov;449(5):520-8

12) L. Kleinberg, V.A. Flørenes, I. Silins, K. Haug, C.G. Trope, J.M. Nesland, B. Davidson. Nuclear Expression of surviving is associated with improved survival in metastatic ovarian carcinoma. Cancer. 2007 Jan 15;109(2):228-38

13) Q. Wu, R.A. Lothe, T. Ahlquist, I. Silins, C.G. Trope, F. Micci, J.M. Nesland, Z. Suo, G.E. Lind. DNA methylation profiling of ovarian carcinomas and their in vitro models identifies HOXA9, HOXB5, SCGB3A1 and CRABP1 as novel targets. Mol Cancer. 2007 Jul 10;6:45

14) B. Davidson, M. Skrede, I. Silins, I.M. Shih, C.G. Trope, V.A. Flørenes. Low-molecular weight forms of cyclin E differentiate ovarian carcinoma from cells of mesothelial origin and are associated with poor survival in ovarian carcinoma. Cancer. 2007 Sep 15;110(6):1264-71

15) H.P. Dong, L. Kleinberg, I. Silins, V.A. Flørenes, C.G. Trope, B. Risberg, J.M. Nesland, B. Davidson. Death receptor expression is associated with poor response to chemotherapy and shorter survival in metastatic ovarian carcinoma. Cancer. 2008 Jan 1;112(1):84-93

16) Q. Wu, G.E. Lind, H.C. Aasheim, F. Micci, I. Silins, C.G. Trope, J.M. Nesland, R.A. Lothe, Z. Suo. The EPH receptor Bs (EPHBs) promoters are unmethylated in colon and ovarian cancers. Epigenetics. 2007 Oct-Dec;2(4):237-43

17) F. Micci, J. Weimer, L. Haugom, R.I. Skotheim, R. Grunewald, V.M. Abeler, I. Silins, R.A. Lothe, C.G. Trope, N. Arnold, S. Heim. Reverse painting of microdissected chromosome 19 markers in ovarian carcinoma identifies a complex rearrangement map. Genes Chromosomes Cancer. 2008 Oct30.