Primary Cytoreductive Surgery Versus Interval Debulking Surgery Following Neoadjuvant Chemotherapy in Epithelial Ovarian Cancer: An Institutional Review

Objective To compare the overall survival of women with advanced-stage EOC treated by PCS versus NACT followed by IDS. Design, Setting, and Participants Retrospective study of women with stage IIB–IVA ovarian carcinoma FIGO staging diagnosed between 2016 and 2018 treated at Department of Surgical Oncology, Sri Aurobindo Medical College and Post Graduate Institute, Indore. Exposures Initial treatment approach of PCS versus NACT + IDS, examined using an intent-to-treat analysis. Results The median follow-up was 18 months (10–36 months) in both groups. The median overall survival was 38 months in PCS group and 31 months in NACT group. Postoperative complications were seen more often in PCS group (11.3%) against 3.33% in NACT group. Patients with residual disease (microscopic and macroscopic residual disease) had poorer prognosis. Conclusions Primary cytoreductive surgery is associated with improved survival compared with NACT in otherwise healthy women with bulky epithelial ovarian. The biggest risk associated with the use of NACT is that patients with significant side effects and refractory disease will lose the opportunity for initial surgery. The lower survival in women receiving NACT can be owed to limited performance status in women undergoing NACT.