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Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy
  1. A. Rafii*,
  2. B. Deval,
  3. J.-F. Geay,
  4. N. Chopin*,
  5. X. Paoletti§,
  6. D. Paraiso and
  7. E. Pujade-Lauraine
  1. *Service de Chirurgie, Institut Claudius Regaud, Toulouse, France;
  2. Service de Chirurgie Gynécologique, Centre Hospitalier Universitaire Nancy, Nancy, France;
  3. Service de Biostatistiques, Hôpital Bichat, Paris, France; and
  4. §Département d'Hématologie et d'Oncologie Médicale, Hôpital Hôtel-Dieu, Assistance Publique—Hôpitaux de Paris (AP—HP), Paris, France
  1. Address correspondence and reprint requests to: Arash Rafii, MD, Service de Chirurgie, Institut Claudius Regaud, 31052 Toulouse, France. Email: rafii.arash{at}


The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan–Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54%) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22%) patients had a simple biopsy, and 25 (24%) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95% confidence interval [CI], 19.5–29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95% CI, 5.4–24.9 months) than patients who had optimal primary surgery (22.9 months; 95% CI, 15.6–30.1 months), nonoptimal primary surgery (27.1 months; 95% CI, 21.2–32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95% CI, 23.5–67.5 months) (P= .001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.

  • neoadjuvant chemotherapy
  • stage IV ovarian cancers
  • surgery

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  • The first and the second authors contributed equally to this work.

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