Perioperative outcomes after interval cytoreductive surgery and primary cytoreductive surgery for advanced epithelial ovarian cancer in Australia: A National Gynae-Oncology Registry (NGOR) study.

OBJECTIVE

The National Gynae-Oncology Registry (NGOR) is an Australian Clinical Quality Registry (CQR). This study reports data on surgical outcomes in patients who underwent cytoreductive surgery for Stage III-IV epithelial Ovarian/Tubal/Peritoneal (OTP) cancer between 2017 and 2022. This study aims to understand rates of perioperative adverse events, complete and optimal cytoreduction, and factors that contribute to this in addition to comparing overall survival (OS) in those who undergo primary cytoreduction (PCS) versus interval cytoreduction (ICS). In doing so, this study aims to evaluate current Australian practice.

METHOD

All women with Stage III-IV epithelial OTP cancer who underwent cytoreductive surgery between 2017 and 2022 registered with the NGOR were included (N = 1084). Outcomes included: rates of postoperative complications (Clavien Dindo Grade III+), PCS and ICS, complete and optimal cytoreduction, OS, intraoperative complications, and the effects of rurality, performance status, age and socioeconomic status on these outcomes.

RESULTS

PCS was undertaken in 470 (43 %) patients and ICS in 614 (57 %) patients. Postoperative complications were more common in those who underwent PCS versus ICS (p = 0.025 and p = 0.009 respectively). Optimal cytoreduction (macroscopic residual disease <1 cm) was more commonly achieved at ICS (p = 0.047). No difference was observed between groups for complete cytoreduction. Median OS was 4.1 years [IQR 3.9-4.4] with those undergoing PCS surviving longer than those who undergo ICS after propensity matching (p < 0.001).

CONCLUSION

ICS was associated with less perioperative morbidity, and increased rates of optimal cytoreduction when compared with PCS in patients with Stage III-IV epithelial OTP cancer. PCS was, however, associated with improved overall survival in this registry cohort. This is consistent with international literature and this study uses national CQR data to report on current Australian practice.