Surgical quality and long-term outcomes in advanced ovarian cancer: a population based registry study from Hamburg, Germany 2014–2024

Purpose To evaluate the association of surgical quality and survival in patients with advanced ovarian cancer in a real-world setting. Methods This population-based registry study analysed FIGO stage III/IV ovarian cancer patients in Hamburg, Germany (2014–2024). Patients were categorized by surgical outcome (no macroscopic residuals vs. macroscopic residuals). Kaplan–Meier functions and Cox proportional hazards models estimated associations with survival outcomes. Results The cohort comprised 576 patients (median age 65 years, median follow-up 57 months). No macroscopic residuals were achieved in 370 patients (64.2%). In multivariable analysis, no macroscopic residuals were associated with reduced mortality risk (HR 0.62, 95% CI: 0.42–0.90) and reduced progression risk (HR 0.68, 95% CI: 0.49–0.94). Advanced FIGO stage, poor performance status, and increasing age were independent predictors of worse outcomes. Conclusion Achieving no macroscopic residuals remains a critical prognostic factor in advanced ovarian cancer. The rate of 64.2% demonstrates that optimal surgical outcomes are achievable in routine practice, though opportunities for improvement remain compared to specialized centres.