Introduction/Background The aim of this video is to show the different surgical techniques performed for debulking in advanced ovarian cancer.

Methodology Observational and retrospective study of 101 women who had primary cytoreductive surgery (PDS) or those that received neoadjuvant chemotherapy followed by interval debulking surgery (IDS) between January 2008-March 2023.

The chosen case was because several techniques were associated: Omentectomy, excision of implants in the serous of the colon, splenectomy, cholecystectomy and segmental hepatectomy due to intraparenchymal metastatic invasion in IV segment and tumor invasion of the gallbladder.

The techniques and maneuvers performed are detailed in the video.

Results With an overall mean follow-up of 42 months. 47 women (PDS) and 28 (IDS) women were included.

Rates of complete resection (R0) were 72.3% of patients after PDS and 57.2% of patients after IDS (p=0.217). Postoperative rates of adverse effects and mortality were slightly higher after PDS than after IDS (p=0.793).

Median progression-free survival was 60 months in the PDS group and 52 months in the IDS group (p=0.04). Factors in multivariable analysis associated with increased risk of recurrence included residual tumor >1cm (HR: 2.72, 95% CI 1.06–6.98, p= 0.037) and stable/progression in response to chemotherapy (HR 8.85, 95% CI 1.76–44.45, p= 0.008).

Median overall survival was not reached for the PDS group and 78 months for the IDS group (HR: 1.63, 95% CI 0.72–3.65, p= 0.235) and 28 months for the ChT group (HR: 2.47, 95% CI 1.13–5.39, p=0.022).

Conclusion Higher complete cytoreduction rate indicates that the correct patients have been selected and those that benefit the most.

Disclosures Complete resection of all macroscopic disease (at primary or interval surgery) was the strongest independent variable in predicting overall survival (HR: 4.52, 95% CI 1.86–11.02, p= 0.001).