Optimal cytoreductive surgery is an independent prognostic indicator in stage IV epithelial ovarian cancer with hepatic metastases

Objectives. The aim of this study was to determine the value of optimal cyt oreduction in stage IV epithelial ovarian cancer. Methods. A retrospective review was performed of 37 women with stage IV epi thelial ovarian cancer treated by radical surgery. Results. Optimal surgery to less than 2 cm tumor deposits was performed in 16 of the 37 cases (43%) and tumor debulking to less than 1 cm tumor deposi ts in 6 cases (16.2%). Twenty-three cases (62%) were designated stage IV be cause of the presence of liver metastases alone. Although no patients died within 2 weeks of surgery, 7 of the 37 cases (22%) failed to survive more t han 50 days after primary surgery. The overall median survival was 11 month s with overall 2- and 5-year survivals of 23 and 9%, respectively. On multi variate analysis comparing age, histological type, tumor grade, place of su rgery, secondary surgical procedure, performance of bowel surgery, presence of liver metastases, and optimal cytoreduction, only optimal surgery and r esidual tumor deposits of less than 2 cm, or less than 1 cm, remained highl y significant (P = 0.0029 and 0.0086, respectively). Even when assessing on ly the 27 cases who were designated as having stage IV disease because of t he presence of liver metastases, by multivariate analysis, only optimal sur gery and residual tumor deposits of less than 2 cm, or less than 1 cm, rema ined significant (P = 0.023 and 0.036, respectively). Site of metastases de signating stage IV status was not associated with a reduced likelihood of a chieving optimal debulking (P = 0.18). Conclusion. Optimal cytoreduction in women with stage IV epithelial ovarian cancer with or without hepatic metastases is associated with a more favora ble outcome survival, (C) 2000 Academic Press.