The potential for optimal (less than or equal to 2 cm) cytoreductive surgery in advanced ovarian carcinoma at a tertiary medical center: a prospective study.

From November 1980 to April 1985, 50 consecutive previously untreated patients with FIGO Stage III and IV ovarian cancer were entered into a prospective trial to evaluate what percentage of such patients could have their tumors optimally cytoreduced (residual cancer less than or equal to 2 cm), what operation is required to achieve this goal, and what is the associated morbidity. Optimal cytoreduction was achieved in 76% of the 50 cases and in 77% of 18 cases referred as "inoperable." To achieve this goal, the six most common operations performed in descending order of frequency were bilateral salpingo-oophorectomy (100%), hysterectomy (98%), omental resection (86%), peritoneal tumor resection (40%), intestinal resection (36%), and gastrocolic ligament resection (16%). Fifty-eight percent of the patients had no major complications. The most significant complications were congestive heart failure in 4% and pulmonary embolus in 4%. Ninety-four percent of the patients had chemotherapy initiated in less than or equal to 14 postoperative days. It is concluded that approximately three-fourths of patients with advanced Stage III and IV ovarian carcinoma can have their tumors resected to less than or equal to 2 cm in greatest diameter. The value of such therapy on ultimate response to chemotherapy and survival will have to await longer follow-up, and will be the subject of a subsequent report.