Adjuvant chemotherapy followed by interval debulking surgery versus upfront surgery followed by chemotherapy in advanced epithelial ovarian carcinoma

AbstractBackground/objectivePatients with advanced ovarian cancer should be treated by radical debulking surgery aiming at complete tumor resection. Unfortunately, approximately 70% of patients present with advanced disease, when optimal debulking cannot be obtained, and, therefore, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NAC) followed by interval debulking surgery has been proposed as a novel therapeutic approach in such cases.MethodsA prospective randomized controlled study was conducted on 30 women selected from patients attending the gynecologic clinic of El-Shatby Maternity University Hospital, Alexandria, Egypt. Cases were randomly divided into two groups. Group I included 15 women who were undergoing upfront surgery, followed by adjuvant chemotherapy. Group II included 15 women subjected to NAC, followed by interval debulking surgery.ResultsWe found that optimal cytoreduction was higher in the first group (86.7%) compared with the upfront surgery group (6.7%). Additionally, we also observed that surgical aggressiveness (blood-loss rates, bladder injury, gynecologic impedance tomograph intervention) and postoperative morbidity (intensive care unit admission, sepsis, duration of hospital stay) were both significantly lower in the first group relative to the upfront-surgery group.ConclusionThis study found that interval debulking surgery is a better option relative to upfront surgery based on intra- and postoperative morbidity, provided that optimal debulking of all tumor tissue is achieved during that surgery