Gynecologic Oncology

Annals of Surgical Oncology

, Volume 19, Issue 13, pp 4059-4067

First online:

Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer

  • Suk-Joon ChangAffiliated withDepartment of Obstetrics and Gynecology, Ajou University School of Medicine Email author 
  • , Robert E. BristowAffiliated withDivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine Email author 
  • , Hee-Sug RyuAffiliated withDepartment of Obstetrics and Gynecology, Ajou University School of Medicine

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To analyze the impact of radical cytoreductive surgery—as part of primary tumor debulking—on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery.


Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC–IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected.


Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients. Advanced age (hazard ratio [HR] 1.04, 95 % confidence interval [CI] 1.02–1.06, P < 0.01), FIGO stage IV disease (HR 3.61, 95 % CI 1.48–8.83, P < 0.01), and grossly visible RD (HR 3.24, 95 % CI 1.90–5.53, P < 0.01) were identified as significant factors associated with poor prognosis in the entire cohort of 203 patients. Radical surgery (HR 0.56, 95 % CI 0.37–0.87, P = 0.01) was associated with improved survival. In the subgroup of patients with stage IIIC disease with peritoneal carcinomatosis, independent prognostic factors were advanced age (HR 1.04, 95 % CI 1.01–1.06, P = 0.01), radical surgery (HR 0.58, 95 % CI 0.35–0.96, P = 0.03), and grossly visible RD (HR 2.86, 95 % CI 1.55–5.30, P < 0.01). Patients with no gross RD had the longest overall survival (86 months) compared with RD 0.1–1 cm (46 months) and RD >1.0 cm (37 months) (P < 0.01).


No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.