Introduction/Background The rates of maximal effort cytoreduction increase gradually in the last decades and surgical debulking of ovarian cancer implants in the upper abdominal cavity involve the excision of multiple organs including the spleen. In the present study, we sought to determine the factors that affect the survival rates of these patients.

Methodology The study was based on a retrospective chart review of patients undergoing debulking surgery between January 2009 and December 2022. Patients were subgrouped according to the setting (primary debulking, interval debulking, and secondary debulking) of the operation and site of splenic metastases. Multivariate analysis of survival functions was assessed with logistic regression, naïve Bayes, classification and regression trees, random forest, and neural network analysis using Python.

Results Overall, 90 patients with advanced ovarian cancer were considered for the analysis. Of those, 60 patients underwent high and 30 underwent intermediate complexity score procedures. We observed that patients with hilar splenic metastases had significantly better recurrence-free survival (RFS) compared to those with surface or parenchymal metastases (103 months vs 34 vs 47 months log-rank=.05). Patients offered primary debulking surgery had significantly better RFS compared to those undergoing interval or secondary debulking (log-rank=.013). Surgical complexity did not influence patients` RFS. Random forest analysis achieved the best predictive accuracy with an AUC .943. Operative setting (PDS, IDS, secondary debulking) provided the best source of information gain in the predictive algorithm. Neither the type of metastases (hilar, surface, parenchymal) nor the setting of operation or surgical complexity score influenced patients` overall survival (OS). Random forest analysis once again achieved the best predictive accuracy with an AUC .983.

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Abstract #339 Figure 1

Overall Survival and Recurrence Free Survival of PDS, IDS, and Secondary Debulking subgroups

Conclusion Patients undergoing splenectomy for advanced ovarian cancer seem to have a more favorable prognosis in terms of PFS when hilar metastases are present. In the setting of PDS, PFS is better, compared to IDS or secondary debulking.

Disclosures No conflict of interest and funding.