Introduction/Background The aim of this metanalysis is to compare the morbidity and mortality in patients undergoing Primary Cytoreductive Surgery (PCS) compared to Neoadjuvant Chemotherapy (NACT) and Interval Cytoreductive Surgery (IDS) for advanced ovarian cancer.
Methodology A literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed for publications reporting morbidity and mortality in patients undergoing PCS compared to NACT and ICS. A total of 1341 citations were reviewed; 17 studies comprising 3759 patients were selected for the analysis.
Results Patients in the PCS group were significantly more likely to have a Clavien-Dindo grade ≥3 morbidity with an overall rate of 21.2% compared to 8.8% (95% CI 1.9–4.0, p<0.0001). Patients in the PCS group were more likely to die within 30 days of surgery (OR 6.1, 95% CI 2.1–17.6, p=0.0008). Patients who underwent NACT + ICS had significantly shorter procedural times (MD −35 minutes, p=0.01), lost less blood intraoperatively (MD −382 ml, p<0.001) and had an average admission 5.0 days shorter (MD −5.0 days, 95% CI −8.1 – −1.9 days, p=0.002) than those undergoing PCS. Patients undergoing NACT were twice as likely to receive optimal and complete cytoreduction (OR 1.9, 95% CI 1.3–2.9, p=0.001, and OR 2.2, 95% CI 1.5–3.3, p=0.0001 respectively).
Conclusion While NACT and IDCS resulted in significantly less morbidity and mortality with improved complete cytoreduction rates compared to PCS, this did not confer improved survival. Hence NACT is a feasible alternative in particular for patients with co-morbidities or high tumour burden.
Disclosure Nothing to disclose.
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