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Abstract
Introduction/Background Achieving a status of no residual disease (CC 0) following cytoreductive surgery in advanced epithelial ovarian cancer (EOC) is crucial for favourable prognoses in affected women. The challenge lies in enhancing CC 0 rates without elevating morbidity and avoiding chemotherapy delays.
Methodology This quality improvement study investigated 559 women with advanced EOC who underwent cytoreductive surgery from January 2014 to December 2019 at a UK, tertiary referral centre of excellence for ovarian cancer surgery. The study introduced the Enhanced Recovery After Surgery (ERAS) pathway, prehabilitation protocols and multi-disciplinary surgical approach when required, triggering a paradigm shift in the surgical management of advanced EOC patients towards maximal surgical effort cytoreduction in 2016. The evaluation of surgical outcomes encompassed parameters before, during, and after this shift. The study strictly followed the ESGO guidelines for the peri-operative surgical management of advanced EOC patients. The primary focus was on residual disease (RD), while secondary outcome measures included post-operative morbidity, operative time (OT), length of stay (LOS), and progression-free survival (PFS).
Results An escalation of the CC 0 rates from 57.3% to 74.4% after the paradigm shift was observed, without concurrent changes in peri-operative morbidity or chemotherapy delays. Although the mean OT extended from 133 ± 55 to 197 ± 85 minutes, and post-operative high-dependency unit admissions rose from 8.1% to 33.1%, the subsequent mean LOS increased modestly from 7.0 ± 2.6 to 8.4 ± 4.9 days. The ESGO QI score improved from 27 to 34. The median PFS was 33 months, showing no significant differences in the three-time frames but hinting at a potential improvement trend.
Conclusion Improving CC 0 rates without compromising morbidity is attainable under specific conditions. Maximal effort cytoreductive surgery is advocated exclusively in high-output tertiary referral centres, acknowledging the substantial prerequisites and ramifications associated with such endeavours.
Disclosures There are no conflicts of interest.
