Ultra-radical surgery for advanced ovarian cancer: a retrospective cohort study in a tertiary referral cancer center in the UK

Abstract

BackgroundOvarian cancer is the leading cause of death from gynaecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and e cacy of this extensive surgery. ObjectiveThe aim of this study is to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our ndings with the current literature. MethodsThis is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate. ResultsThe study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease free survival time was 2.9 years while median disease free survival time was 2 years. Age (p=0.028) and complete cytoreduction (p=0.048) were found to be signi cantly associated with survival. Primary debulking surgery was signi cantly associated with lower probability of recurrence (p=0.049). ConclusionAlthough the number of patients is relatively small, our study indicates that ultra-radical surgery in centres with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited Gynaecological Oncologist and a Hepatobiliary General Surgeon with a special interest in ovarian cancer. A few cases required input from a Colorectal and a Thoracic Surgeon. We believe that the careful selection of the patients that can bene t from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to Page 3/18 establish that ultra-radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.