Advanced epithelial ovarian cancer: no difference in survival rate between exploratory laparotomy and inadequate debulking surgery as treatment approach before chemotherapy.

In this study we have retrospectively evaluated 40 untreated patients with stage III-IV (FIGO) epithelial ovarian cancer. Sixteen patients had received, as initial treatment, inadequate surgical removal of the tumor with bulky residue (BR) of disease and 24 had had an exploratory laparotomy (EL) only. Subsequently, both groups received equivalent chemotherapy consisting of AC combination (adriamycin, cyclophosphamide) in 25 patients. Following surgery plus chemotherapy the two groups achieved a similar high remission rate (BR patients: 73% with AC scheme and 80% with PEC scheme; EL patients: 57% with AC and 100% with PEC). Furthermore, when all responsive patients were surgically re-explored, there was a pathologically complete remission in 5/12 BR patients and in 4/10 EL patients. Median survival was 20 months (range 3-50) in BR patients and 16 months (range 3-31) in EL patients. The statistical comparison between the two groups showed no significance; similarly, there was no significant difference in comparing AC-treated with PEC-treated patients. These data show that in poor risk patients with advanced ovarian carcinoma, inadequate surgery with BR is not prognostically superior to EL alone; therefore, chemotherapy as first treatment approach could be a valid alternative to surgery in such cases.