Introduction/Background Low-grade serous ovarian cancer (LGSOC) is a recent histologic diagnosis. The surgical approach of this disease has been little investigated and modeled on the management of high-grade serous ovarian carcinoma. The prognostic impact of the largest dimension of residual disease after primary surgery is still debated. This study evaluates the impact of size of residuals after primary debulking surgery (PDS) on progression-free (PFS) and overall survival (OS) in patient with advanced LGSOC.

Methodology A comprehensive search of PubMed and Cochrane Library databases was conducted to obtain all the studies from 1/2005 to 1/2023 evaluating progression-free and overall survival in patients with no residual disease (CC0 - CC1) as compared to patients with residual disease (CC2) after PDS for LGSOC. Meta-analysis was performed, and survival outcomes were calculated.

Results A total of 12 relevant studies (2030 patients) were identified for analysis. The proportion of PDS was 87%. The median proportion of patients in each cohort undergoing suboptimal cytoreductive surgery (CC2) was 27%. The median follow-up for all cohorts was 22 months (16.7–56.8) in PFS and 72 months (48.3–130.7) in OS. The presence of residual disease (CC2) after primary debulking surgery had a significant negative impact on PFS (HR = 2.50, 95% CI = 1.95–3.21, p<0.01), and on OS (HR = 2.27, 95% CI = 1.50–3.43, p<0.01).

Conclusion For advanced LGSOC, primary debulking surgery with macroscopic residual disease is associated with poor survival in PFS and OS. Primary debulking surgery with no gross residual peritoneal disease should be preferred when it is possible.

Disclosures All the authors have no potential conflict of interest to report.