Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: surgical and oncological outcomes. single institution experience

Objective. The objective of the present study was to determinate the impact of maximal cytoreductive surgery on progression free survival, overall survival rates and morbidity, in patients with advanced epithelial ovarian or fallopian tube cancer (stage IIIC-IV) treated in a referral cancer center. Methods. After obtaining Institutional Review Board approval, we reviewed all medical records of patients with stage IIIC–IV epithelial ovarian cancer who were managed at our institution between January 2001 and December 2008. Individual records were reviewed and the following information collected: age at surgery, date of surgery, American Society of Anestesiology (ASA) class, primary site of disease, presence of peritoneal carcinomatosis, histologic type and tumor grade, pre-operative serum CA-125 level, location and size of the largest tumor mass, the initial ascites volume (if present), all surgical procedures performed, size of residual disease after surgery. The Kaplan–Meier method was used to estimate survival curves. Cox proportional hazards regression was performed to identify independent prognostic variables for overall survival by univariate and multivariate analysis. Results. A total of 269 patients with advanced epithelial ovarian cancer were referred to our institution between January 2001 and December 2008, and of them 240 consecutive patients met inclusion criteria for the study. The median age was 58 years (range 22 to 77 years). After a median follow up of 29.8 months, the overall median survival (OS) and progression free survival (PFS) were 61.1 and 20.4 months respectively. On univariate analysis, factors significantly associated with decreased survival included: age grater than median (>60 years), presence of ascites >1000 cc, diffuse peritoneal carcinomatosis, omentum as anatomical location of the largest tumor mass, positive lymph-nodes and diameter of residual disease. On multivariate analysis confirmed the independent association of age grater than 60 years and residual disease > 5 mm with worse survival. Conclusion. Our study seems to demonstrate that a more extensive surgical approach is associated with improved survival in patients with stages IIIC-IV epithelial ovarian cancer. Age grater than 60 years and residual tumor grater than 5 mm were independently associated with a worse prognosis.