Introduction/Background Primary debulking surgery (PDS) for advanced epithelial ovarian cancer aims to resect all macroscopically visible lesions. Previous studies showed a discrepancy of 20–48% between the surgeon’s intraoperative assessment of residual tumor (RT) and findings on postoperative computed tomography (CT) scans. Patients with radiographical lesions that were suspicious of malignancy had worse prognosis. The current study aimed to compare the postoperative CT findings to the surgeon’s intraoperative assessment at our centre and to determine their effect on survival.

Methodology All patients with newly diagnosed FIGO stage III-IV ovarian, tubal, or primary peritoneal cancer who underwent complete or near complete PDS (RT < 2.5 mm) at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS hospital in Rome, Italy, between June 2019 and June 2021 and in whom CT evaluation was performed within 50 days from PDS were included. CT-scans were assessed using a 5-point scale, ranging from normal to definitely malignant. Indeterminate results were omitted from further analyses.

Results A total of 145 patients were identified. Clinical data and postoperative CT-scans could be retrieved from 102 patients. Of these patients, CT findings corresponded to the surgeon’s intraoperative assessment in 77.5% of cases. In 13 patients (12.7%), CT findings were scored as indeterminate. Lesions that were deemed probably malignant or definitely malignant were found in seven (6.9%) and three patients (2.9%), respectively, with a median lesion size of 24.5 mm (range 8.0–85.0 mm). Most lesions were reported in the left flank. Comparing radiologically concordant and discordant findings, no differences in progression-free survival (17.7 versus 18.9 months, p = 0.463) or overall survival (20.0 versus 22.8 months, p=0.087) were seen.

Conclusion In line with previous data, a discrepancy of 22.5% was found between surgeon’s intraoperative assessment and postoperative CT-scan on the presence of RT. Nonetheless, CT findings did not affect survival outcomes.