Trends in Surgical Outcomes and Overall Survival Among Women Undergoing Debulking Surgery for Advanced Ovarian Cancer in the U.S: Analysis of the National Cancer Database

Given the rising use of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC), we sought to assess practice trends in overall survival (OS), complete gross resection (R0), and postoperative mortality following debulking surgery. The National Cancer Database (NCDB) was used to identify 34,982 stage IIIC and IV EOC patients between 2010 and 2017 who underwent surgery. Annual proportions of patients receiving IDS and PDS were calculated. Median OS was estimated using the Kaplan–Meier method. Joinpoint models were fitted to evaluate surgical trends. Statistics were performed using SPSS and Joinpoint. Of 34,982 patients, 10,460 (29.9%) underwent IDS. IDS patients were older, more likely to have stage IV disease, and more likely to be non-White. Median OS was higher in the PDS group (54 vs. 38.8 months, p < 0.001). Postoperative 90-day mortality was lower in the PDS group (1.7% vs. 2.4%, p < 0.001), though IDS patients had a lower 30-day readmission rate (6.2% vs. 3.1%, p < 0.001). IDS patients were less likely to undergo extensive surgery (27.4% vs. 36.7%, p < 0.001) and more likely to achieve R0 resection (42% vs. 38.6%, p < 0.001). The IDS rate increased from 18.9% to 40.6% (annual percentage change (APC): 11.8%, p < 0.05) from 2010 to 2017. Median OS improved from 46.6 to 51 months (APC: 1.9%, p < 0.05), driven by the PDS cohort. The R0 resection rate rose from 34.8 to 41% (APC: 2.65%, p < 0.01), driven by the PDS cohort (APC: 2.83%, p < 0.01). Postoperative 90-day mortality decreased from 2.4% to 1.5% (APC: −4.64%, p < 0.05), due to a reduction in PDS patients (APC: −6.83%, p < 0.05). There was no change in the rate of extensive surgery over time. In conclusion, from 2010 to 2017, increased triage of patients to NACT was accompanied by a higher R0 resection rate and reduced postoperative mortality in PDS patients, with no observed detriment to OS. This data suggests improvement in case selection between IDS and PDS.