Original Investigation

In patients with advanced ovarian cancer, primary suboptimal surgery has better survival outcome than interval suboptimal surgery

10.4274/jtgga.2018.0015

  • Alpaslan Kaban
  • Samet Topuz
  • Pınar Saip
  • Hamdullah Sözen
  • Yavuz Salihoğlu

Received Date: 05.02.2018 Accepted Date: 12.03.2018 J Turk Ger Gynecol Assoc 0;0(0):0-0 [e-Pub] PMID: 29545229

Objective:

It is known that optimal or complete cytoreduction is the most important factor in patients with advanced ovarian cancer. The aim of this study was to examine the results of patients who did not undergo optimal cytoreduction and to examine subgroup analysis based on neoadjuvant chemotherapy.

Material and Methods:

Patients with advanced ovarian cancer and suboptimal surgery were retrospectively reviewed.

Results:

A total of 99 patients with a median age of 59.0 (22-87) were studied. The median follow-up time was 39±32.7 months, 81 patients (81.8%) died and 18 patients (18.2%) were alive. Five-year survival rate was 27.6%. Of patients, 37 (37.4%) were operated after neoadjuvant chemotherapy (NAC), 62 (62.3%) were primary. Patients with NAC had more deaths within 3 years compared to without NAC (83.9% vs 56.0%) (p=0.015). Patients with NAC had less tumor spread (presence of visible tumor at upper abdomen during surgery) (29.7% vs 72.6%; p<0.001) and had less overall survival times when compared to patients who underwent primary surgery (median 22.3±1.2 [95% CI: 19.9-24.7] vs 37.5±11.2 [95% CI: 15.4-59.5] months; Log Rank test p=0.055). Relationship between overall survival and factors which age, NAC, presence of metastasis upper abdomen, and tumor histology (serous vs non-serous) were analyzed by univariate cox regression analysis. Of these factors, only NAC was a factor close to significant (p=0.055).

Conclusion:

NAC reduces tumor burden before surgery in advanced ovarian cancer. The prognosis of patients who are not eligible for optimal surgery despite neoadjuvant chemotherapy is worse than patients who do not receive NAC.

Keywords: primary surgery,neoadjuvant chemotherapy,cytoreductive surgery,survival