Cytoreductive Surgery for Tubo-ovarian Carcinoma - A study of surgical outcomes with primary surgery.

Introduction / Background: Primary debulking/cytoreductive surgery (PDS) is considered the optimal approach in management of tubo-ovarian carcinoma (TOC). Not all patients are suitable for primary surgery, and neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (IDS) is considered to be not inferior to PDS. At this Irish tertiary gynaecological oncology centre the treatment approach is determined by the multidisciplinary team (MDT). Objective: The aim of this study was to analyse the operative outcomes of the MDT decision to assign patients to primary surgery.Methodology: An observational retrospective study of consecutive patients with TOC presenting during 2018. Borderline, low grade and non-epithelial tumours were excluded.Results: Eighty-eight patients were assessed by MDT and of 57 eligible, radiological stage was I/II (16, 28%), III (25, 44%), IV (16, 28%). Most were high grade serous histology. Thirty patients (52.6%) had PDS. Surgery included hysterectomy (29, 96.67%), salpingo-oophorectomy (30, 100%), appendicectomy (27, 90%) , omentectomy (30, 100%) , small bowel resection (2, 6.67%), large bowel resection (11, 36.67%), splenectomy (3,10%), partial gastrectomy (5, 16.67%), diaphragmatic stripping (8, 26.67%), partial resection of diaphragm (7, 23.33%) , pelvic lymphadenectomy (30, 100%), para-aortic lymphadenectomy (30, 100%). Complete cytoreduction was achieved in 27 (90%). Blood loss average 1361 (50-5100) mls. Duration of surgery average 207 (30-385) mins. Post operative stay average 17.7 (4-84) days . Clavien dindo scores average 2. There were two postoperative deaths. Twenty-four (80%) progressed to chemotherapy.Conclusion: Most women presenting with TOC had advanced stage disease. Those assigned to primary surgery had multiple procedures but the majority achieved complete cytoreduction. Perioperative morbidity and mortality were substantial. Only 80% of PDS progressed to adjuvant chemotherapy. Disclosure: Nothing to disclose