EXTENSIVE CYTOREDUCTIVE SURGERY IN ADVANCED OVARIAN-CARCINOMA

From June 1985 to June 1993, 152 patients with advanced ovarian cancer were treated with maximum cytoreductive surgery, and six to nine cycl es of platinum-based chemotherapy. Six patients had stage IIIA-B disea se, 101 stage IIIC, and 45 stage IV. Twenty-two tumors were grade 1, 5 8, grade 2, and 72, grade 3. Eighty-four patients (55%) presented with bulky tumors (>10 cm in diame ter). Optimal cytoreductive surgery (di ameter of largest residual mass 12 cm) was performed in 138 patients ( 91%). Fifty patients (33%) developed postoperative complications; 38 p atients (25%) required a second laparotomy within a few days. Two post opera tive deaths occurred. Overall 2-year and 4-year survival rates w ere 56% and 28%, respectively There was a clear relationship between r esidual tumor and survival: the 2-Siear survival rate was 80% in the a bsence of residual tumor vs. 22% when the residuum exceeded 2 cm in di ameter. The 2-year survival rate was 49% for tumor nodules >2 cm in di ameter. In a multivariate analysis of various risk factors (grade, sta ge, lymph node metastases, residual tumor, and age), the one that corr elated most with survival was residual tumor. Despite a high morbidity rate, this modality of treatment, with the presence of optimal and ag gressive perioperative measures in terms of intensive care unit and po st-operative follow-up, offers an encouraging if not promising strateg y for increased chances of survival in advanced ovarian cancer.