Introduction/Background To evaluate the influence of surgical strategy on survival for patients with stage III or IV epithelial ovarian cancer (EOC).
Methodology Retrospective data collection in a single and reference cancer center. Currently the strategies in advanced ovarian cancer are changing. Our purpose was to analyse the Overall Survival (OS) and Disease Free Survival (DFS) comparing the ‘state of the art’ procedures, Primary Debulking Surgery (PDS) and interval surgery after 3–6 cycles of Neoadjuvant Chemotherapy (NAC). Incidentally, we tested the risk factors for recurrence.
Results Median age was 59 years (40–80). Exploratory laparoscopy was performed in 52 patients, 28 underwent PDS and 24 NAC. Median Laparoscopic Predictive Score (Fagotti) was 2.2 (0–6) and 5.8 (2–10) (p=0.00), median Peritoneal Carcinomatosis Index was 12.5 (2–18) y 18.3 (10–24) (p=0.00) and mean of Ca125 prior to surgery was 489 y 949 U/dL (p=0.00) respectively. Pelvic and para-aortic lymphadenectomy was performed in 20 patients during PDS (14 cases with involved nodes, 48%) and 19 patients during interval surgery NAC (in 6 cases with involved nodes, 25%) (p=0.11). The median Surgical Complexity Score (Aletti) was 5 and 6.5 (p=0.21), with 80 and 24 points in the Comprehensive Compilation Index (modified from Clavien-Dindo Classification) for complications respectively (p=0.13). There were not significant differences in the complete resection rate (61 vs 63%, p=0.99), DFS (12 vs 15 months, p=0.80), and 5-years OS (59 vs 25%, p=0.32). Complete surgery were significantly associated with a better OS in univariate analysis (Hazard ratio 3.34 (95% CI, 1.19–9.40, p=0.015).
Conclusion A significative improvement of OS has been observed in relation with complete tumour resection (microscopial residual tumor). In this study, NAC is non-inferior to PDS and is an acceptable standard of treatment of advanced and bulky EOC.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.