Efforts at maximal cytoreduction improve survival in ovarian cancer patients, even when complete gross resection is not feasible

Objective We sought to determine survival associated with residual disease (RD) after primary debulking surgery (PDS) for advanced ovarian cancer (OC), and evaluate impact on complications and survival after practice changes to improve PDS. Methods Outcome variables were collected for patients undergoing PDS for FIGO (2009) stage IIIC OC from 2003 to 2011. The cohort was divided into time periods (2003–2006 vs. 2007–2011), before and after cytoreduction standardization. RD categories were: RD0, RD 0.1–0.5 cm, RD 0.6–1.0 cm, and RD > 1 cm. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Results 447 patients (mean age, 65.3 years) met inclusion criteria. RD for the entire cohort: RD0 = 44.5%; RD 0.1–0.5 cm = 30.9%; RD 0.6–1.0 cm = 11.4%; and RD > 1 cm = 13.2%, with median OS of 58 months, 35 months, 29 months, and 22 months, respectively. OS was significantly better for RD0 vs. all other RD categories (p ≤ 0.001), and for RD 0.1–1.0 cm vs. RD > 1 cm (p = 0.01). RD0 improved from 32.7% to 54.3% (p < 0.001), and RD > 1 cm decreased from 20.3% to 7.3% (p < 0.001) when comparing the 2003–2006 (n = 202) vs. 2007–2011 (n = 245) cohorts. Surgical complexity increased in the latter time period (24.3% vs. 41.2%). 30-day Accordion grade 3–4 morbidity remained consistent (18.8% vs. 20.8%, p = 0.60), 30-day mortality decreased (4.5% to 1.2%, p = 0.035), and median OS improved from 36 to 40 months after cytoreduction standardization. Conclusion Patients with RD0 had longest OS, with survival advantage for RD1 when compared to RD > 1 cm. These data support PDS to lowest RD even when RD0 cannot be obtained. Practice improvement efforts can increase RD0 rates, improving OS without compromising morbidity.