Suboptimal primary debulking vs neoadjuvant chemotherapy followed by interval debulking: Where does the balance tilt?
Jaber S, Buekers TE, Hanna RK, Munkarah AR, and Rasool N. Suboptimal primary debulking vs neoadjuvant chemotherapy followed by interval debulking: Where does the balance tilt? Gynecol Oncol 2017; 145:129-130.
Objective: To compare clinical outcomes in stage IIIC/IV ovarian cancer patients who undergo suboptimal primary debulking (SPDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking. Method: We performed a retrospective chart review of patients with stage IIIC/IV primary ovarian, fallopian tube, or peritoneal cancer diagnosed at our institution between January 1993 and December 2014. Demographic characteristics, surgical procedures, and major postoperative complications between the SPDS and NACT groups were compared. Analyses were performed using t test and ?2 test.The Kaplan-Meier method was used for survival analysis. Results: Among the stage IIIC/IV ovarian cancer patients diagnosed during the study period, 224 patients received primary debulking surgery. Of those, 93 patients underwent SPDS (42%), compared to 66 in the NACT group. Mean age at diagnosis for the SPDS group was 62 years (±12) vs 65 years (±13) for the NACT group. In the SPDS group, 70% were stage IIIC and 30% were stage IV, while for the NACT group, 38% had stage IIIC and 62% had stage IV (P b 0.0001) in the SPDS group, 77% had poorly differentiated histological grade. There was no significant difference in the types of procedures performed between the two groups. Patients in the SPSD group had higher risk of hemorrhage (blood loss = 1 liter) (19 patients in SPDS vs 3 patients in NACT, P = 0.001). No statistically significant differences in admissions to the intensive care unit, postoperative ileus, or thromboembolic events were noted between the two groups. Mean length of hospital stay (LOS) for SPDS was 8 days (± 2) versus 5 days (±3) for NACT (P = 0.047). The mean time to starting chemotherapy following surgery in SPDS was 26 days (±17). Overall survival for SPDS was 2.8 years (95% CI 2.0-3.6) and NACT 3.1 years (95% CI 2.1-4.0) with P = 0.19. Conclusion: The survival outcome of advanced-stage ovarian cancer patients who undergo NACT is comparable to that of patients undergoing SPDS. Surprisingly, the frequency of major complications in many categories was not significantly different between the two groups.