Introduction/Background Surgery remains one of the main treatment modalities for the treatment of ovarian cancer. Patients with advanced stage disease will likely undergo neo-adjuvant chemotherapy as the majority of surgeons is not familiarized with maximal effort cytoreduction. The purpose of the present study is to evaluate morbidity and mortality outcomes of ovarian cancer patients undergoing procedures with and intermediate and high complexity score.

Methodology We performed a retrospective chart review of patients undergoing intermediate and high complexity procedures (according to the Mayo Clinic classification system) between 2008 and 2020. We assessed morbidity and survival outcomes in order to evaluate which subgroups benefited the most from maximal effort cytoreduction.

Results Overall 107 patients were included with a median duration of follow-up of 45 months (24–156). The median surgical complexity score was 7 (4–15). The progression free and overall survival rates of the entire cohort were 28 (22 – 34) and 47 (37–57) months respectively. Sixteen patients experienced a grade IIIB Clavien-Dindo complication. Median high dependency unit stay was 3 days (1–15). Five patients required hospitalization in the intensive care unit. Patients undergoing primary debulking had a clear overall survival benefit compared to patients that had interval debulking surgery (54 months (40–67) vs 35 months (24–46)). Kaplan Meier curves revealed that the difference became evident among patients that survived for at least 50 months. Recurrence free survival was not influenced by this parameter. A progressive decrease in overall survival rates was observed with advancing stage. Complexity of the procedure (intermediate vs high) did not affect survival rates of patients.

Conclusion Maximal effort cytoreduction is feasible and is accompanied by acceptable morbidity and mortality rates. Primary debulking should be considered in appropriately selected patients as this considerably increases overall survival rates of patients.