Outcome of primary cytoreduction surgery for advanced epithelial ovarian carcinoma

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Seventy-nine consecutive patients with Stage III or IV epithelial ovarian carcinoma underwent primary cytoreduction surgery at the Cleveland Clinic over a 10-year period (1975 to 1985). Optimal cytoreduction, defined as a residual with a diameter of 2 cm or less, was achieved in 35 patients (44.3%). Women with disease that could undergo cytoreduction with optimal results had greater chances of survival without significantly increased risk for postoperative morbidity or mortality than those in whom results were not optimal. Multivariate stepwise logistic regression analysis revealed four covariates (stage of disease, cell type, distended abdomen, and age at operation) that were independently significant in predicting the ability to reach an optimal state at the completion of cytoreductive surgery. Multivariate stepwise Cox proportional hazards regression analysis revealed cytoreductive status, stage of disease, ascites, eligibility for second-look laparotomy, and parity to be factors significantly related to survival. Until prospective studies are completed, cytoreductive surgery remains the state of the art for the treatment of advanced epithelial ovarian carcinoma.



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