Introduction/Background Surgery has a central role in treatment of advanced ovarian cancer. Various incidence of the surgical procedures in the upper abdominal cavity is reported. This study aims to elucidate surgical outcome after advanced upper abdominal surgery.

Methodology 375 patients eligible for surgery for stage IIB-IV ovarian/tubar/peritoneal cancer at the Academic Uppsala University hospital, Sweden, between 2014 and 2022 were included in this study. Inclusion criteria were primary or interval debulking, complete or near to complete (max 2,5 mm residual disease) cytoreduction. T-test and Chi-square-test were used.

Results Complete cytoreduction was achieved in 334/375 (89.1%) cases and near to complete cytoreduction in 41/375 (10.9%) cases. Incidence of complete cytoreduction was higher at stages IIB-III (91.9%) compared to stage IV (82.3%), Chi-square=4.42, p=0.04. High-grade 30-days postoperative complications occurred in 63/375 (16.8%) cases. Incidence of splenectomy was 183/375 (48.8%). Incidence of high-grade postoperative 30-days complications after splenectomy was 46/183 (25.1%) compared to 17/192 (8.8%) when splenectomy was not performed (Chi-square=17.8, p<0.01). Peritoneal cancer index (PCI) was 3-fold higher for patients who underwent splenectomy compared to those who did not need the procedure, 25 and 8, correspondently. Incidence of extirpation of non-regional bulky nodes (cardiofrenic, hepatic hilum and celiac) was 84/375 (22.4%). Incidence of high-grade 30-days postoperative complications after extirpation of non-regional bulky nodes (17/84 – 20.2%) and when procedure was not performed – 43/287 (15%) was similar (Chi-square=1.32, p=0.3). An average PCI for patients who underwent extirpation of non-regional bulky nodes was 25.

Conclusion Significantly more high-grade 30-days postoperative complications occurred after splenectomy, but not after extirpation of the non-regional bulky nodes compared to when procedure was not necessary. However, incidence of splenectomy and of the extirpation of non-regional bulky nodes is associated with increased PCI, a previously identified by us strong predictor of high-grade postoperative complications.