Die Bedeutung der radikalen zytoreduktiven Chirurgie für die Überlebenszeit von Patientinnen mit fortgeschrittenem Ovarialkarzinom

Purpose: The aim of this study was to assess prognostic factors that may have an impact on overall survival in patients with advanced epithelial ovarian cancer who underwent extensive primary cytoreductive surgery (debulking). Material and Methods: Between 1996 and 2001 we assessed the clinical history of 99 patients with primary advanced ovarian cancer (FIGO III/IV) who underwent cytoreductive surgery at the Department of Gynecology at the Universitatsklinikum Hamburg-Eppendorf. Results: Maximal efforts were directed towards a complete resection of all visible tumor manifestations prior to initiation of systemic chemotherapy (92% platinum based, 72% paclitaxel combinations). In 85% of our patients we achieved optimal cytoreduction (no residual disease 58%, residual tumor size < 1 cm in 27%). Major morbidity occurred in 31% and mortality was 3%. Median follow-up was 25 months. The estimated median survival was 48 months for the entire group (Stage III + IV). In the group with residual tumor of 9mm and below median survival was 60 months. Cox regression revealed no residual disease as the only significant prognostic factor for reduced mortality (HR 0.61 [0.428-0.87]). Conclusion: Complete cytoreduction is feasible in a majority of patients with advanced epithelial ovarian cancer (FIGO III + IV) with limited rates of complications, as radical surgery prolongs survival time substantially. Our data demonstrate that success of extensive cytoreductive surgery is independent on tumorbiology or the pattern of intraabdominal spread of the disease. Therefore, patients with initially extensive spread of tumor deposits should always undergo maximal primary cytoreductive surgery with the aim of complete tumor resection.