Implementation of extensive cytoreductive surgery protocol in advanced epithelial ovarian cancer: Real-world data on surgical treatment distribution and survival of the whole patient cohort; a single center experience

Abstract

Introduction: The aim was to assess the effect of the implementation of maximal surgical cytoreduction on the treatment decisions and overall survival of the entire patient cohort with advanced epithelial ovarian cancer. Material and Methods: We collected retrospectively all newly diagnosed patients with FIGO stage IIIB–IVB epithelial ovarian cancer between 2013 and 2019 in Tampere University Hospital, Finland. Altogether, 333 patients were divided into two groups based on the date of diagnosis: Group 1 (n = 162) diagnosed before March 2016 and Group 2 (n = 171) after 1st of March 2016, when a systematic change in surgical approach toward maximal surgical cytoreduction was implemented in our institution. Results: No statistically significant differences were found in the proportions of patients having surgery or treated non-surgically between the two time periods: 76.5% of patients in Group 1 and 71.9% in Group 2 underwent surgical treatment, while the others were treated with chemotherapy only or referred directly to palliative care (p = 0.38). In addition, there was no statistically significant difference in overall survival in patients who received any treatment (surgery and chemotherapy or chemotherapy only) between groups: the median overall survival was 32.8 months (95% CI 25.1–40.5) in Group 1 and 37.3 months (31.5–43.1) in Group 2, p = 0.214. Conclusions: The change in surgical approach toward maximal surgical cytoreduction in advanced epithelial ovarian cancer did not significantly change the magnitude of patients who received only chemotherapy or underwent surgical treatment in our center. While the shift in surgical paradigm may provide survival benefits for carefully selected surgically treated patients, it did not result in a statistically significant improvement in overall survival for the entire patient cohort.