What question did this study set out to answer?

To compare tumor burden, operative complexity, and cytoreductive outcomes between PDS-ACT and NACT-IDS in stage III–IV EOC.

May 30, 2026

Descriptive comparison of primary debulking surgery (PDS-ACT) versus neoadjuvant chemotherapy with interval debulking (NACT-IDS) in stage III–IV epithelial ovarian cancer: Single-center experience.

Key Points

To compare tumor burden, operative complexity, and cytoreductive outcomes between PDS-ACT and NACT-IDS in stage III–IV EOC.
Conducted a retrospective cohort study at Al-Bairouni University Hospital
Analyzed medical records of patients with stage III–IV EOC treated with PDS-ACT or NACT-IDS
Measured tumor burden and operative complexity metrics for both surgical approaches.
Higher baseline tumor burden and operative complexity observed in the PDS group
NACT-IDS achieved a higher rate of complete/optimal cytoreduction (75.9% vs 39.0%)
Higher early postoperative morbidity was reported for PDS, with longer hospital stays and acute renal failure rates.

Abstract

e17598 Background: Optimal cytoreduction remains a cornerstone of management for advanced epithelial ovarian cancer (EOC). We compared tumor burden, operative complexity, perioperative morbidity, and cytoreductive outcomes between primary debulking surgery followed by adjuvant chemotherapy (PDS-ACT) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in a retrospective single-center cohort. Methods: This is a study conducted at Al-Bairouni University Hospital—Syria’s national cancer center serving 65–70% of the country’s cancer patients. Institutional ethical approval was obtained to perform the study. We conducted a retrospective cohort chart review of patients with stage III–IV EOC treated with PDS-ACT or NACT-IDS. Data were abstracted from Al-Bairouni medical records and operative documentation and harmonized for analysis. Results: Baseline tumor spread markers were more frequent in the PDS group (large ascites >500 mL 24.4% vs 6.9%; multiple mesenteric nodules 61.0% vs 22.8%; multisectional intestinal infiltration ≥3 segments 65.9% vs 24.1%; multiple liver metastases 31.7% vs 15.2%; fused enlarged lymph nodes 39.0% vs 8.3% for PDS vs IDS). Operative PCI >10 occurred in 61.0% of PDS vs 37.9% of IDS. IDS involved more multivisceral procedures (rectal resection 24.1% vs 4.9%; any peritonectomy 31.0% vs 12.2%). Open-and-close occurred in 9.8% (PDS) vs 5.5% (IDS). Early postoperative morbidity was higher after PDS (long hospitalization 24.4% vs 10.3%; acute renal failure 12.2% vs 1.4%). Completeness of cytoreduction favored IDS: complete/optimal cytoreduction 75.9% (110/145) vs 39.0% (16/41) in PDS. Conclusions: In this retrospective single-center cohort, patients undergoing PDS had higher baseline tumor burden and higher operative PCI, whereas NACT-IDS achieved higher complete/optimal cytoreduction despite more frequent multivisceral procedures. Prospective studies including survival outcomes are needed to contextualize these findings. Key outcomes in PDS-ACT vs NACT-IDS (stage III–IV EOC). Variable PDS-ACT (n=41) NACT-IDS (n=145) Large ascites >500 mL 10/41 (24.4%) 10/145 (6.9%) Multiple mesenteric nodules 25/41 (61.0%) 33/145 (22.8%) Intestinal infiltration ≥3 segments 27/41 (65.9%) 35/145 (24.1%) Operative PCI >10 25/41 (61.0%) 55/145 (37.9%) Rectal resection 2/41 (4.9%) 35/145 (24.1%) Any peritonectomy 5/41 (12.2%) 45/145 (31.0%) Long hospitalization 10/41 (24.4%) 15/145 (10.3%) Acute renal failure 5/41 (12.2%) 2/145 (1.4%) Complete/optimal cytoreduction 16/41 (39.0%) 110/145 (75.9%) Values are n/N (%). PDS-ACT: primary debulking surgery + adjuvant chemotherapy; NACT-IDS: neoadjuvant chemotherapy + interval debulking surgery.

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