DOES DEBULKING SURGERY IMPROVE SURVIVAL IN BIOLOGICALLY AGGRESSIVE OVARIAN-CARCINOMA

Aggressive tumor reduction surgery has been widely used in patients wi th advanced stage epithelial ovarian carcinoma before initiation of cy totoxic chemotherapy. No randomized controlled trial has been carried out to confirm the benefits of such procedures. To examine the role of cytoreductive surgery in the management of stage 2 and 3 patients wit h epithelial ovarian carcinoma treated with postoperative adjuvant pla tinum-based chemotherapy, survival analysis was carried out on patient s with initial microscopic disease documented on staging laparotomies, patients with large volume of disease at time of exploration and tumo r reduced to microscopic residuals, and patients who were suboptimally debulked with more than 2-cm residual disease, Twenty-four, 81, and 1 91 patients were identified from a computerized data base, respectivel y. Kaplan-Meier survival estimates showed that 62% with initial micros copic residual are alive with no evidence of disease at 5 years and 56 % of patients left with microscopic residuals after tumor reduction ar e alive and well at 5 years. There was no statistical significant diff erence between these two groups. The groups are equivalent with respec t to known adverse prognostic factors. Ln contrast, 5-year survival in the suboptimal debulked group was significantly lower at 15%. Debulki ng surgery to achieve microscopic residual disease improved the progno sis in patients with initial large volume of disease. Survival was sim ilar to survival in patients with microscopic disease at time of explo ration. The beneficial effect may be attributed to the removal of chem oresistant clones in bulky tumors. Tumor reduction surgery remains imp ortant in the management of advanced stage epithelial ovarian carcinom a. (C) 1997 Academic Press.