title: Surgical Complexity Impact on Survival After Complete Cytoreductive Surgery for Advanced Ovarian Cancer.
abstract: The direct relationship between surgical radicality to compensate biologic behavior and improvement of patient outcome at the time of primary or interval cytoreduction remains unclear.
  
  
  
  The aim of this study was to evaluate the impact of disease extension and surgical complexity on survival after complete macroscopic resection for stage IIIC-IV ovarian cancer.
  
  
  
  Medical records from seven referral centers in France were reviewed to identify all patients who had complete cytoreductive surgery for stage IIIC-IV epithelial ovarian, fallopian, or primary peritoneal cancer. All patients had at least six cycles of carboplatin and paclitaxel combination therapy.
  
  
  
  From the 374 consecutive patients with complete cytoreduction who were included in this study, stage, grade, upper abdominal disease, surgical complexity, and carcinomatosis extent were significantly associated with disease-free survival (DFS) at univariate analysis. Stage IV and the need for ultra-radical procedures were significantly associated with lower overall survival (OS). On multivariate analysis, radical surgery, including more than two visceral resections, was significantly associated with decreased DFS and OS.
  
  
  
  Patients who need complex surgical procedures involving two or more visceral resections in order to achieve successful complete cytoreduction have worse outcome than patients with less extensive procedures. The negative impact of surgical complexity was not significant in patients who underwent upfront procedures. Tumor volume and extension were associated with decreased DFS in patients undergoing a primary surgical approach. This adds to the evidence that, even though complete cytoreduction is currently the objective of surgery, tumor load remains an independent poor prognostic factor and probably reflects a more aggressive behavior.
authors.affiliation: Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France. martinez.alejandra@iuct-oncopole.fr.
authors.forename: A
authors.initials: A
authors.lastname: Martinez
authors.affiliation: Department of Surgical Oncology, Hôpital Georges Pompidou APHP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ngo
authors.affiliation: Department of Surgical Oncology, Institut Oscar Lambret, Lille, France.
authors.forename: E
authors.initials: E
authors.lastname: Leblanc
authors.affiliation: Department of Surgical Oncology, Institut Goustave Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Service de Gynécologie et Andrologie - Board Onco-Gynécologie Institut roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Luyckx
authors.affiliation: Department of Gynecologic Oncology, Hôpital Tenon APHP, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Darai
authors.affiliation: Department of Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Department of Surgical Oncology, Institut Bergonié, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Guyon
authors.affiliation: Department of Surgical Oncology, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Pomel
authors.affiliation: Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Ferron
authors.affiliation: Department of Biostatistics, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
authors.forename: T
authors.initials: T
authors.lastname: Filleron
authors.affiliation: Department of Surgical Oncology, Institut Bergonié, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Querleu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D016190:Carboplatin / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005602:France; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D016190:Carboplatin; D017239:Paclitaxel