title: Initial incomplete surgery modifies prognosis in advanced ovarian cancer regardless of subsequent management.
abstract: BACKGROUND
  Prognosis in ovarian cancer is determined by completeness of cytoreduction and proper management by specialized oncological gynecologists. Incomplete initial debulking surgery in non-specialized Centers is, however, a reality and there is ongoing discussion about the best subsequent management of such patients.
  
  
  METHODS
  Patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics--FIGO FIGO stages IIIC-IV) who had biopsy by laparotomy or incomplete cytoreduction followed or not by chemotherapy further referred to our Institution between January 2002 and May 2014 were included. The two groups of incomplete cytoreduction [followed by upfront surgery or followed by chemotherapy and interval debulking surgery (IDS)] were compared and also compared against a cohort of 197 patients with similar characteristics who underwent upfront maximal surgery according to the standard at our Iinstitution during the same period.
  
  
  RESULTS
  A total of 99 eligible patients were identified. Sixty-seven of them underwent biopsies by laparotomy and 32 underwent incomplete cytoreduction in other institutions. Twenty-eight patients underwent direct re-operation while 71 patients underwent neoadjuvant chemotherapy followed by IDS. The mean overall survival duration for patients with upfront reoperation was 31 months and 54 months for patients with neoadjuvant chemotherapy and IDS, considerably lower than the 72 months obtained for the group of 197 patients with maximal up-front complete cytoreduction at our Institution.
  
  
  CONCLUSIONS
  Primary biopsy or incomplete cytoreduction reduces survival regardless of the subsequent approach. However, if incomplete cytoreduction has occurred, neoadjuvant chemotherapy followed by IDS is preferable to up-front reoperation.
authors: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania nicolae_bacalbasa@yahoo.ro.
authors: Nicolae
authors: N
authors: Bacalbasa
authors: Ponderas Hospital, Bucharest, Romania.
authors: Irina
authors: I
authors: Balescu
authors: Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: Simona
authors: S
authors: Dima
authors: Pathology Department, Fundeni Clinical Institute, Bucharest, Romania.
authors: Vlad
authors: V
authors: Herlea
authors: Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: Leonard
authors: L
authors: David
authors: Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: Vladislav
authors: V
authors: Brasoveanu
authors: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: Irinel
authors: I
authors: Popescu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D016896:Treatment Outcome
keywords: Advanced ovarian cancer; IDs; biopsy; incomplete cytoreduction; interval debulking surgery; neoadjuvant chemotherapy