Outcome of Primary Cytoreductive Surgery Versus Interval Debulking Surgery following Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

Background: Neoadjuvant Chemotherapy (NACT) reduces the tumor burden before interval debulking surgery, in patients with advanced epithelial ovarian cancer to achieve complete tumor resection during the surgical procedure. Aim: To compare the outcome of the primary debulking surgery and interval debulking surgery following NACT in advanced epithelial ovarian cancer. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka. The study was conducted over a period of one year. Histopathologically confirmed ovarian neoplasm patients who attended the Department of Gynae Oncology,DMCH for surgical management were included in this study. By purposive sampling method, 23 patients in each group were included maintaining the inclusion and exclusion criteria. Statistical analysis of the results was performed by using window based computer software devised with Statistical Packages for Social Science ( SPSS-23). Results: The data consists of two groups: PDS (23 individuals) and IDS (23 individuals). The mean age was 44.48 ± 14.50 years for the PDS group and 47.17 ± 17.35 years for the IDS group. The most common presenting complaints were abdominal distension (n=21) and pain (n=21), followed by a lump in the lower abdomen (n=17), anorexia, and nausea (n=10). The PDS group exhibited a significantly higher mean CA-125 level (576.08 ± 603.82) compared to the IDS group (p<0.05). Regarding CA-19.9 levels and LDH the PDS group had a significant higher mean than IDS group. The median tumor size was 150 cm3 in the PDS group and 48 cm3 in the IDS group (p<0.05). Operation time and intraoperative blood loss were significantly higher in the PDS group (168 min, 774 ml) compared to the IDS group (148 min, 519 ml) with a p-value of <0.034. Post-operative hospital stay was relatively shorter in the IDS group. Optimal cytoreduction was achieved in 73.9% of cases in the IDS group and only 47.8% of cases in the PDS group. Regarding post-operative complications, symptoms were less prevalent in the IDS group in comparison to the PDS group. One patient in the PDS group experienced post-operative death. Conclusion: Interval debulking surgery (IDS) approach had significant higher advantages in comparison to PDS group.