Objective: Women aged ≥80 years with ovarian cancer (OC) are significantly underrepresented in clinical trials, and their optimal management remains poorly defined. This study aimed to evaluate clinicopathologic characteristics and survival outcomes in this understudied population. Material and Methods: This retrospective study included 43 women aged ≥80 years diagnosed with advanced OC between 2009 and 2024 at a tertiary care center. Clinical, pathological, and treatment data were collected. Kaplan-Meier and Cox regression analyses were used to evaluate time to progression (TTP) and overall survival (OS). Results: The mean age was 83.4±4.1 years (range: 80-101); 95.3% had at least one comorbidity, and 46.5% had polypharmacy. Despite advanced age, 86% of patients underwent cytoreductive surgery and 79.1% received chemotherapy. Optimal cytoreduction (≤1 cm) was achieved in 89.2% of surgically treated patients, with no gross residual disease (R0) obtained in 64.9%. During a median follow-up period of 21.4 months, 76.7% of patients died. The median TTP was 20.9 months [95% confidence interval (CI): 0.0-42.8], and the median OS was 27.1 months (95% CI: 14.9-39.2). The 2 years TTP and OS rates were 49.4%±9.3 and 56.2%±7.8, respectively. Notably, cytoreductive surgery was associated with improved OS (hazard ratio: 0.171; p=0.001). Conclusion: Cytoreductive surgery can achieve high rates of optimal and complete resection in carefully selected women aged ≥80 years with advanced OC when performed at experienced, high-volume centers. These findings indicate that advanced chronological age alone should not be considered a contraindication to surgical evaluation in fit octogenarians.
