Introduction/Background Primary and Interval Debulking/Cytoreductive Surgery (PDS and IDS) are standard of care for surgical management of advanced stage 3 and 4 epithelial Ovarian/Fallopian Tubal Cancer. There has been very little research regarding outcomes of Delayed Debulking Surgery (DDS); performed upon completion of adjuvant chemotherapy.Aim to evaluate survival following DDS and compare cytoreductive outcomes, post-operative morbidity, PCI scores and survival outcomes in women who underwent PDS, IDS, DDS.
Methodology Prospective data collection and retrospective review of all cases that underwent DDS in our centre from 1/7/2014 to 31/12/2020.
Results All 384 patients were divided in PDS (n=109), IDS (n=235) and DDS (n=40). Mean age of the entire cohort was 64 years old. PDS and IDS group were comparable, and DDS has significantly higher comorbidities like cardiovascular and diabetes. Overall R=0 was achieved in 70% of cases with a further 12% of residual under 0.5 cm. Ongoing mean overall survival (OS) is 56 months and the complexity of surgery did not significantly impacted morbidity (mean length of hospital stay 7 days) or survival rates. There was a significant survival benefit seen with complete cytoreduction (R0) in primary, interval and delayed debulking surgery (p<0.05) and OS was not statistically different in between the three groups (p<0.05). Age over 70 years, performance status, ASA score and residual tumour volume negatively correlated to overall survival after logistic regression. On Cox regression analysis, the hazard ratio was significantly higher for R>2 cm in all sub-groups (HR=2.7, 95% CI-1.23–6.07, p<0.05).
Conclusion Delayed debulking surgery is a safe and oncologically acceptable option for women who have missed the opportunity for clinical and/or personal reasons to undergo surgery in the primary or interval setting. We recommend that all cases that did not have surgery to be considered for surgery at completion of their chemotherapy by MDT.
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