title: Neo-adjuvant chemotherapy does not increase the rate of complete resection and does not significantly reduce the morbidity of Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer.
abstract: OBJECTIVE
  To measure the efficacy and the safety of Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer and to compare the outcomes before and after chemotherapy.
  
  
  METHODS
  Between 2008 and 2013, 200 consecutive patients were offered VPD for stage IIIC/IV ovarian cancer. Exclusion criteria were: metastases in the lungs or 3 liver segments at CT review and/or disease on small bowel serosa or encasing the porta hepatis at explorative laparoscopy. The endpoints were efficacy (rate of complete resection, CR) and safety (morbidity and mortality). The results were compared between patients in group 1 (upfront surgery) and group 2 (during or after chemotherapy).
  
  
  RESULTS
  Ninety-eight patients were in group 1 and 102 in group 2. Twenty out of 200 patients (10%) did not have VPD, 180 out of 200 patients (90%) had VPD and CR: 90.8% in group 1, 89.8% in group 2. The mortality (1%) and intra-operative complication rate (3.3%) were similar. Post-operative complications rate was 34.8% in group 1 vs. 30.7% in group 2 (P=0.669). The difference in grade III (15.7% vs. 5.5%, P=0.053) and grade IIIb complications (13.4% vs. 4.4%, P=0.062) approached statistical significance. All other outcomes were not significantly different in the 2 groups.
  
  
  CONCLUSIONS
  VPD achieved CR in 90% of the patients. Neo-adjuvant chemotherapy did not increase the rate of CR and did not significantly decrease the morbidity or the complexity of the surgery.
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK. Electronic address: roberto.tozzi@obs-gyn.ox.ac.uk.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tozzi
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Giannice
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cianci
authors.affiliation: Department of Gynaecology, San Raffaele-Giglio Foundation, Cefalu', Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tardino
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Riccardo Garruto
authors.initials: RG
authors.lastname: Campanile
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Kumar
authors.initials: K
authors.lastname: Gubbala
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fachechi
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Federico
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Igor
authors.initials: I
authors.lastname: Martinek
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
authors.forename: Hooman
authors.initials: H
authors.lastname: Soleymani Majd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Complete resection; Morbidity; Ovarian cancer