Journal: Annals of surgical oncology
Study type and population
- Retrospective single-center cohort of 302 unselected patients with FIGO/AJCC IIIC–IV epithelial tubo-ovarian or primary peritoneal cancer.
- Treatment period: 2006–2021 at an ESGO-certified high-volume center.
- Surgery: all patients underwent maximum-effort primary or interval cytoreductive surgery.
Key surgical features
- Complete macroscopic resection: achieved in 85.8% (259/302).
- High surgical complexity: Surgical Complexity Score ≥ 8 in 73.2%.
- Intestinal surgery: intestinal segment resections in 71.5% of patients; large bowel resection in many, ileocecal resection in 24.5%.
- Major postoperative complications: Clavien-Dindo ≥ IIIb significantly increased by large bowel resection (OR 2.708, p = 0.002).
- Anastomotic leak rate: 6.0%, not significantly influenced by temporary stoma formation.
Survival outcomes
- Complete macroscopic resection: remained strongly associated with better survival.
- Small bowel resection: independently predicted worse overall survival (3-year OS 31.8% vs 57.0%, p < 0.001).
- Ileocecal resections: linked to the poorest outcomes (3-year OS 24.2%, p < 0.001).
- Neoadjuvant chemotherapy use: 13.9%; did not adversely impact long-term survival.
- High surgical complexity: did not adversely impact long-term survival.
Clinical implications
- Prognostic factors: small bowel and particularly ileocecal involvement are adverse prognostic factors even when complete cytoreduction is achieved.
- Morbidity: large bowel resections increase major postoperative morbidity.
- Triage: findings support nuanced preoperative triage; in patients with extensive small bowel/ileocecal disease—especially frail or complex cases—multidisciplinary consideration of primary systemic therapy with planned interval cytoreduction may be more appropriate than immediate maximum-effort primary debulking.