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A Comparison of Survival Outcomes in Advanced Serous Ovarian Cancer Patients Treated With Primary Debulking Surgery Versus Neoadjuvant Chemotherapy
  1. Taymaa May, MD*,,
  2. Robyn Comeau, MD,§,
  3. Ping Sun, PhD,
  4. Joanne Kotsopoulos, PhD,,
  5. Steven A. Narod, MD,,
  6. Barry Rosen, MD# and
  7. Prafull Ghatage, MD,§
  1. * Division of Gynecologic Oncology, Princess Margaret Cancer Center;
  2. Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON;
  3. Division of Gynecologic Oncology, Tom Baker Cancer Centre;
  4. § Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB;
  5. Women's College Research Institute, Women's College Hospital;
  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; and
  7. # Beaumont Medical Group, Gynecologic Oncology, Royal Oak, MI.
  1. Address correspondence and reprint requests to Steven A. Narod, MD, Women's College Research Institute, Women's College Hospital, 76 Grenville St, 6th Floor Toronto, ON, Canada M5S 1B2. E-mail: steven.narod{at}


Objective The management of women with advanced-stage serous ovarian cancer includes a combination of surgery and chemotherapy. The choice of treatment with primary debulking surgery or neoadjuvant chemotherapy varies by institution. The objective of this study was to report 5-year survival outcomes for ovarian cancer patients treated at a single institution with primary debulking surgery or neoadjuvant chemotherapy.

Methods This study included a retrospective chart review of 303 patients with stage IIIC or IV serous ovarian carcinoma diagnosed in Calgary, Canada. The patients were categorized into 1 of the 2 treatment arms: primary debulking surgery or neoadjuvant chemotherapy. The 5-year ovarian cancer–specific survival rates were estimated using Kaplan-Meier curves.

Results Among the 303 eligible patients, 142 patients (47%) underwent primary debulking surgery, and 161 patients (53%) were treated with neoadjuvant chemotherapy. Five-year survival was better for patients undergoing primary debulking surgery (39%) than for patients who received neoadjuvant chemotherapy (27%; P = 0.02). Women with no residual disease experienced better overall survival than those with any residual disease (47% vs. 26%, respectively; P = 0.0002). This difference was significant for those who had primary debulking surgery (P = 0.0004) but not for the patients who received neoadjuvant chemotherapy (P = 0.09). Women who received intraperitoneal chemotherapy had better overall survival as compared with patients who received intravenous chemotherapy (44% vs 30%, respectively; P = 0.002).

Conclusions Our findings suggest that among women with no residual disease, survival is better among those who undergo primary debulking surgery than treatment with neoadjuvant chemotherapy. The latter should be reserved for women who are deemed not to be candidates for primary debulking surgery.

  • Ovarian cancer
  • Serous ovarian cancer
  • Surgical cytoredution
  • Neoajuvant chemotherapy

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  • The authors declare no conflicts of interest.