What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer?

Abstract

To compare the impact, in terms of survival, of complete cytoreduction after primary debulking surgery (PDS) and interval debulking surgery (IDS) in patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stages III-IV) by reviewing the recent literature. A search of the PubMed database during the last 7years (2008-2014) was carried out looking for studies specifically showing data on median survival or disease-free survival after complete cytoreduction after either PDS or IDS. We found 24 publications including 14,182 patients with stages III to IV ovarian cancer. A total of 11871 patients (83.7%) underwent PDS and 2311 (16.3%) underwent interval debulking after neoadjuvant chemotherapy. A total of 4684 patients (33%) were considered completely resected with microscopic residual disease. After PDS, the weighted average of median overall and progression-free survival was 43 and 17months, respectively, for the whole group. After IDS, median and progression-free survival were 33 and 14months. The rate of complete cytoreduction after PDS was inferior to the obtained in patients with IDS (27 vs. 59%). However, the median survival in patients with complete cytoreduction with primary cytoreduction was 23months longer than in the group with interval debulking (69 vs. 45months). Complete cytoreduction after IDS yields a inferior outcome in terms of median survival than PDS of almost 2years. Despite the higher rate of complete resection, IDS apparently fails to improve the results obtained by primary debulking.