COMPLETE CYTOREDUCTIVE SURGERY IS FEASIBLE AND MAXIMIZES SURVIVAL IN PATIENTS WITH ADVANCED EPITHELIAL OVARIAN-CANCER - A PROSPECTIVE-STUDY

Objective. Despite correlation between the completeness of surgical cy toreduction and survival for patients with advanced ovarian cancer, re latively few undergo complete cytoreduction. This study was initiated to prospectively determine the ability to surgically eliminate all vis ible disease in patients with stage IIIC and IV epithelial ovarian can cer and the associated impact on survival. Methods. Between 1990 and 1 996, 163 consecutive patients underwent primary cytoreduction. The goa l was the excision or ablation of all visible disease prior to initiat ion of systemic platinum-based combination chemotherapy. A multivariat e analysis determined which clinical and pathologic variables influenc ed the probability of achieving complete cytoreduction (logistic regre ssion) and survival (Cox proportional hazards model). Results. One hun dred thirty-nine patients (85.3%) underwent removal of all visible tum or, 22 (13.5%) had cytoreduction to less than or equal to 1 cm residua l disease, and 2 (1.2%) had unresected bulky disease. The median and e stimated 5-year survival for the entire cohort was 54 months and 48%, respectively. The probability of achieving complete cytoreduction was influenced independently by the preoperative Gynecologic Oncology Grou p performance status (0-1 vs 2-3, P = 0.04), the number of mesenteric and intestinal serosal implants (less than or equal to 75 vs >75 impla nts, P = 0.005), and stage (IIIC vs IV, P = 0.006). The probability of survival was independently influenced by age (less than or equal to 6 1 vs >61 years, P = 0.003), volume of ascites (less than or equal to 1 vs >1 liter, P = 0.01), stage (IIIC vs IV, P = 0.04), histology (clea r cell and mucinous vs all other, P = 0.03), and the completeness of c ytoreductive operation (complete vs incomplete cytoreduction, P = 0.02 ). Conclusions. Complete cytoreduction is possible for the majority of patients and improves survival, even compared to operations with mini mal (less than or equal to 1 cm) residual disease. Unless their medica l condition prohibits anesthesia and surgery, patients with advanced e pithelial ovarian cancer should undergo primary cytoreductive surgery with the intention of complete tumor removal. (C) 1998 Academic Press.